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Given  by 


HISTORY  AND  REMINISCENCES 


OF    THE 


PHILADELPHIA  ALMSHOUSE 


PHILADELPHIA  HOSPITAL 


D.  HAYES  AGNEW,  M.  D. 
ALFRED  STILLE,  M.  D. 
LEWIS  P.  BUSH,  M.  D. 
CHARLES  K.  MILLS,  M.  D. 
ROLAND  G.  CURTIN,  M.  D. 


Reprinted  from  Philadelphia  Hospital  Reports. 


PHILADELPHIA : 

DETRE  &  BLACKBURN,  35  NORTH  SEVENTH  STREET, 
VOLUME  L— 1890. 


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Digitized  by  the  Internet  Archive 

in  2010  with  funding  from 

Open  Knowledge  Commons 


http://www.archive.org/details/historyreminiscOOagne 


CONTENTS, 


Page. 
THE  MEDICAL  HTSTORY  OF  THE  PHILADELPHIA  ALMSHOUSE.     By 

D.  Hayes  Agnew,  M.D 1 

Administration  under  a  Chief  Resident  Officer 19 

Clinical  Instruction 20 

Certificates  and  Tickets 27 

Administration  by  a  Resident-in-Chief,   and  a  Board  of  Lecturers  on 

Clinical  Medicine  and  Surgery 28 

Museum 33 

Library...  34 

Insane  Department 35 

Apothecaries  and  House  Pupils 38 

Epidemics 41 

EMINISCENCES  OF  THE  PHILADELPHIA  HOSPITAL.     By  Alfked 

Stille,  M.D 56 

ADDITIONAL  REMINISCENCES  OF  THE  PHILADELPHIA  HOSPITAL. 

By  Alfred  Steele,  M.D 64 

REMINISCENCES    OF    THE    PHILADELPHIA    HOSPITAL    AND    RE- 
MARKS ON  OLD-TIME   DOCTORS  AND  MEDICINE.     By  Lewis  P. 

Bush,  M.D 68 

HISTORICAL  MEMORANDA  OF  THE  PHILADELPHIA  ALMSHOUSE. 

By  Chakles  K.  Mills,  M.D 77 

Bibliography  and  Literature  of  the  Philadelphia  Almshouse 79 

Early  Hospitals  and  Almshouses  of  Philadelphia 81 

"Evangeline"  and  the  Philadelphia  Hospital 83 

Methods  of  caring  for  the  Poor  and  Sick  of  Philadelphia 86 

Chief  Executive  Officer  of  the  Almshouse 88 

Removal  of  Almshouse  to  Present  Location 89 

Transfers  and  Sales  of  Almshouse  Lands 92 

Some  Statistical  and  Historical  Facts 94 

Description  of  the, present  Almshouse  Grounds 95 

Description  of  the  present  Almshouse  Buildings r 98 

Additions  and  Improvements 101 

(iii)         . 


IV  CONTENTS. 

EPIDEMICS  IN  THE  PHILADELPHIA  HOSPITAL  FROM  1862  TO  1890. 

By  Roland  G.  Curtin,  M.D ltf 

Typhus  Fever lif 

A  siatic  Cb  olera 16 

Cerebro-Spinal  Meningitis id 

Malignant  Measles II 

Relapsing  Fever 11 

Typhoid  Fever 11 

Puerperal  Fever 11 

Influenza : 11 

NOTES  ON  THE  HISTORY  AND  ORGANIZATION  OF  THE  PHILADEL- 
PHIA   HOSPITAL  SINCE  1860.     By   Charles  K.  Mills,  M.D.,  and 

Roland  G.  Curtin,  M.D 11' 

Officers  of  the  Medical  Board lie 

List  of  Members  of  the  Medical  Board 12C 

Recorder  or  Registrar 124 

Resident  Physicians 125J 

Association  of  Ex-Resident  Physicians 12T] 

Philadelphia  Hospital  Medical  Society 128j 

Children's  Asylum 128] 

The  Insane  Department .- 130 

Pat hologi cal  Department 132 

Neurological  Department 135 

Opbthalmological  Department 136 

Dermatoh  >gical  Department 138 

Lary ngol ogical  Department 138 

The  Mary  Shields'  Almshouse  Fund 139 

The  Training  School  for  Nurses 140 


)£ 


THE  MEDICAL  HISTORY  OF  THE  PHILADELPHIA 
ALMSHOUSE. 


By  D.  HAYES  AGNEW,  M.D.: 


Gentlemen: — I  am  before  you  to-day  by  appointment  of  the 
medical  board,  to  discharge  a  service  preliminary  to  the  opening 
of  the  annual  course  of  clinical  lectures  in  the  hospital.  For 
some  time  I  have  been  engaged  in  gathering  material  from  a  great 
variety  of  sources,  written  and  unwritten,  to  secure  the  history  of 
the  Philadelphia  Almshouse  from  oblivion,  if  not  utter  loss.  The 
field  is  extensive  and  interesting,  though  its  paths  have  been 
much  obscured  by  the  decay  of  time.  So  interwoven  is  it  with 
the  secularities  of  Philadelphia,  that  no  history  of  this  city,  civil. 
political  or  professional,  would  be  complete  with'  ut  it. 

The  medical  history  of  the  Philadelphia  Almshouse  covers  a 
period  of  one  hundred  and  twenty  years,  during  which  time  it 
has  been  located  in  three  different  positions.  First,  on  the  square 
between  Spruce  and  Pine  and  Third  and  Fourth  streets,  at  that 
time  called  the  Green  Meadows :  next  on  the  square  between 
Spruce  and  Pine  and  Eleventh  and  Twelfth  streets,  long  known 

P  Dr.  Agnew  was  a  member  from  1858  to  1865  of  the  surgical  staff  of  the  Philadelphia 
Hospital.  He  was  also  curator  of  the  museum  from  1861  to  1867.  This  •History'"  was 
a  lecture  delivered  at  the  opening  of  the  clinical  lectures  at  the  hospital,  October  15,  1862, 
and  records  the  most  important  medical  facts  connected  with  the  institution  to  that  date.  It 
was  published  by  request  of  the  board  of  guardians,  and  was  printed  by  Holland  &  Edgar. 
54  North  Eighth  street,  Philadelphia ;  but  it  has  long  been  practically  out  of  print.  Dr.  Agnew 
has  kindly  given  his  consent  to  its  re-publication  in  this  volume  of  Reports  to  which  it  forms  a 
fitting  introduction-  A  few  notes  have  been  added  and  a  few  corrections  made,  but  it  is  repro- 
duced nearly  as  originally  published.  The  notes  added  are  placed  in  brackets.  In  the  his- 
torical and  miscellaneous  memoranda,  to  be  given  later,  will  be  found  some  addenda,  relating 
to  facts  occurring  within  the  period  covered  by  Dr.  Agnew,  but  not  mentioned  by  him.] 

The  following  prefatory  acknowledment  is  made  by  the  author :  "  I  am  indebted  to  the 
board  of  guardians  for  free  access  to  the  records  of  the  house  :  to  Drs.  Gin-in  and  Benton,  resi- 
dent physicians  of  the  Philadelphia  Hospital,  for  valuable  assistance  in  searching  these  records; 
to  Mr.  Samuel  Hazzard.  secretary  of  the  Philadelphia  Historical  Society,  for  information 
which  the  works  of  that  library  supplied  :  to  Mr.  Mickley,  whose  rare  collection  of  old  works 
is  unsurpassed:  to  Professors  Jackson  and  Hodge,  and  Drs.  Gerhard  and  Stille.  whose 
acquaintance  with  matters  pertaining  to  the  subjects  treated  on,  proved  of  much  consequence 
in  enabling  me  to  ascertain  facts  connected  with  subjects  on  which  written  documents  were 
silent,  and  to  Mr.  Cavender,  whose  industry  in  arranging  the  records  is  most  praiseworthy." 

(1) 


Z  MEDICAL  HISTORY  OF  THE  PHILADELPHIA  ALMSHOUSE. 

as  the  Society  Grounds ;  and  last,  on  the  west  side  of  the  Schuyl- 
kill river,  where  we  are  assembled  to-day. 

This,  gentlemen,  is  the  oldest  hospital  on  this  continent.1  Proud, 
in  his  history  of  Pennsylvania,  a  work  justly  esteemed  for  its 
research,  says  the  Philadelphia  Almshouse  was  of  later  date  than 
the  Pennsylvania  Hospital,  the  origin  of  which  was  in  1753. 
This  is  a  mistake.  In  1742  it  was  fulfilling  a  varied  routine  of 
beneficentfunctions  in  affording  shelter,  support  and  employment 
for  the  poor  and  indigent,  a  hospital  for  the  sick,  and  an  asylum 
for  the  idiotic,  the  insane  and  the  orphan.  It  was  thus  dispensing 
its  acts  of  mercy  and  blessing,  when  Pennsylvania  was  yet  a  pro- 
vince and  her  inhabitants  the  loyal  subjects  of  Great  Britain, 
more  than  twenty  years  before  a  school  of  medicine  was  founded 
in  this  city,  and  indeed  before  most  of  the  great  events  which 
have  given  the  American  people  a  historical  importance  among 
nations  of  the  earth. 

Who  were  the  first  physicians  appointed  to  attend  the  Phila- 
delphia Almshouse,  and  at  what  period  were  they  assigned  to  this 
duty  ?  These  are  questions,  so  far  as  I  know,  which  cannot  be 
ascertained  either  from  record  or  tradition.'  In  1768,  and  prob- 
ably much  earlier,  Drs.  Cadwalader  Evans  and  Thomas  Bond 
were  the  medical  appointees;  and  on  the  18th  of  May,  1769,  we 
have  a  formal  announcement  of  their  re-election.  The  institution 
at  this  early  period  contained  two  hundred  and  forty-six  inmates, 
and  each  of  the  medical  attendants  received  fifty  pounds  per 
annum,  and  were  required  to  supply  such  medicine  as  was  needed 
for  the  sick. 

Dr.  Bond  studied  his  profession  at  home  and  abroad  ;  was  the 
first  surgeon  and  physician  to  the  Pennsylvania  Hospital,  in 
which  institution  as  early  as  1769  he  delivered  lectures  on  clinical 
medicine  and  surgery.  Dr.  Cadwalader  Evans  was  one  of  the 
first  pupils  of  Dr.  Bond.  In  order  to  finish  his  education  he 
sailed  for  Edinburgh,  but  the  vessel  while  on  the  voyage  was 
taken  by  a  Spanish  privateer  and  carried  to  Hayti,  where  he 
remained  between  two  and  three  years  before  he  was  able  to  renew 
the  voyage  for  the  Scotch  metropolis,  then  the  great  centre  of 
medical  instruction.  It  was  after  his  return  from  Scotland  he 
became  officially  connected  with  the  almshouse. 

I1  Prof.  Wm.  Osier,  formerly  of  the  medical  staff  of  the  hospital,  now  of  Johns-Hopkins 
Hospital,  Baltimore,  in  answer  to  queries,  writes  the  editor  that  the  Hotel  Dieu,  of  Montreal, 
was  founded  in  1612,  and  possibly  some  of  the  Mexican  hospitals  are  older  yet.] 


MEDICAL  HISTORY  OF  THE  PHILADELPHIA  ALMSHOUSE.  d 

That  the  medical  police  of  the  house  was  not  of  the  strictest 
character,  may  be  inferred  from  the  fact  that  a  number  of  persons 
were  in  the  habit  of  visiting  the  institution,  assuming  to  be  doc- 
tors, and  volunteering  their  services  to  the  unfortunate  sick. 
This  irregularity  continued  unquestioned  for  some  time,  until 
many  of  the  patients  had  suffered  very  great  injury,  %and  no 
small  amount  of  discredit  brought  upon  the  management  of  the 
house.  A  resolution  was  at  length  introduced  and  passed  by  the 
board  of  managers,  permitting  no  one  to  prescribe  except  the 
regular  appointees,  and  requiring  them  to  visit  the  hospital 
oftener  and  with  more  regularity. 

At  this  period  the  invaluable  discovery  of  Jenner  was  unknown 
to  the  medical  world,  and  the  only  method  capable  of  diminish- 
ing the  horrors  of  small-pox  was  the  induction  of  the  disease  by 
inoculation,  after  careful  previous  preparation  of  the  system  for 
its  reception.  Singular  as  it  may  appear,  there  were  many  who 
regarded  the  practice  not  only  improper  but  positively  sinful.  I 
remember  a  few  years  ago,  whilst  sitting  in  one  of  our  city 
churches,  taking  up  a  Bible  which  bore  on  the  fly  leaf  the  in- 
scription, over  the  signature  of  the  owner,  "  opposed  to  corpora- 
tion and  inoculation."  In  1771  the  institution  contained  a  num- 
ber of  destitute  children  who  had  never  had  an  attack  of  variola. 
For  their  own  as  well  as  the  safety  of  the  other  inmates,  Dr. 
Evans  called  the  attention  of  the  managers  to  this  fact,  and  pro- 
posed that  they  should  be  protected  by  inoculation.  The  board 
acquiesced  in  the  suggestion,  provided  the  house  should  be  sub- 
jected to  no  expense  other  than  the  medicine  required  for  their 
subsequent  treatment.  Twenty-one  of  these  children  were  sepa- 
rated from  the  general  mass  for  this  purpose,  all  of  whom  per- 
fectly recovered.  In  the  month  of  February,  1778,  there  were 
forty  others  subjected  to  a  similar  course  with  a  like  result. 

In  1772  a  proposition  was  made  to  the  managers  to  extend  the 
usefulness  of  the  house  by  the  admission  of  students,  and  an 
increase  in  the  number  of  medical  attendants.  The  proposition 
included  an  offer  of  gratuitous  service,  the  institution  being  only 
at  the  expense  of  purchasing  the  medicines  required  for  the  sick. 

On  the  25th  of  March,  1774,  the  desired  addition  to  the  medical 
corps  was  effected  by  the  election  of  Dr.  Adam  Kuhn,  professor 
of  materia  medica  and  botany  in  the  Medical  College ;  Dr.  Ben- 
jamin Rush,  who  held  the  chair  of  chemistry  in  the  same  institu- 
tion ;  Dr.  Samuel  Duffield,  one  of  the  ten  alumni  who  received 


4  MEDICAL  HISTORY  OF  THE  PHILADELPHIA  ALMSHOUSE. 

the  first  medical  degrees  conferred  in  this  country  (21st  June, 
17GS),  and  Dr.  Girardus  Clarkson.  An  additional  physician,  Dr. 
Thomas  Parke,  was  added  to  the  number  March  25,  1774.  This 
probably  is  the  origin  in  this  country  of  gratuitous  professional 
service  to  public  institutions  which  has  become  so  general  at  the 
present  day,  and  which  I  conceive  operates  disadvantageously  to 
both  he  who  dispenses  and  he  who  receives.  To  advocate  such  a 
sentiment  brings  no  odium  on  the  profession.  It  requires  no 
argument  from  me  to  vindicate  our  calling  from  the  charge  of 
selfishness.  It  is  not  saying  too  much  when  we  venture  the 
assertion,  that  among  the  professions  there  are  none  which  con- 
tribute so  largely  their  free-will  offerings  for  the  relief  of  human 
suffering,  or  which  furnish  so  many  examples  of  disinterested  and 
unselfish  benevolence  as  our  own. 

I  cannot  refrain  here  from  relating  an  anecdote  somewhat 
apropos  to  this  subject.  The  late  professor  Chapman,  while  dis- 
charging the  clinical  duties  of  his  chair  in  the  University  of 
Pennsylvania,  had  brought  before  him  a  poor  Irish  woman  who 
had  applied  for  advice.  The  doctor  made  a  careful  examination 
of  her  case,  ordered  a  prescription  to  be  made  out,  and  bade  her 
in  a  kindly  tone  to  retire.  With  great  simplicity  of  manner  she 
tendered  compensation,  which,  on  being  declined,  in  an  air  of 
mingled  surprise  and  doubt,  she  exclaimed,  "  Take  the  trifle,  my 
jewel,  for  its  yourself  must  be  after  living."  "Ah!  my  good 
woman,"  said  the  doctor  in  his  own  inimitable  way,  "  we  doctors 
are  a  very  peculiar  people,  we  look  for  our  reward  hereafter." 

To  every  American  the  year  1776  is  full  of  historic  importance. 
A  period  when  our  revolutionary  sires,  men  of  large  hearts,  broad 
minds  and  self-sacrificing  spirits,  were  freely  spending  their  blood, 
treasure  an'd  wisdom  to  establish  a  national  independence  and 
government,  which  their  children  are  to-day,  in  a  spirit  of  un- 
parallelled  venture,  rending  to  pieces. 

On  the  5th  of  September,  1776,  the  "  Council  of  Safety,"  through 
its  president,  Thomas  Wharton,  Jr.,  addressed  a  note  to  the  mana- 
gers of  the  Bettering  House,1  as  it  was  often  styled,  asking  per- 

[l  The  term  "  Bettering  House,"  in  times  gone  by,  was  frequently  applied  to  the  Philadel- 
phia Almshouse,  and  probably  to  institutions  of  the  same  kind;  occasionally  it  is  still  used  by 
the  aged  ;  in  my  boyhood  I  remember  often  hearing  it.  The  most  probable  derivation  of  the 
word  is  from  the  German  Bettler-Haus  or  Beggar  House.  The  word  probably  took  its  start 
among  the  German  communities  of  Pennsylvania  if  this  is  its  origin.  In  form  it  would  seem 
to  refer  to  the  fact  that  the  almshouse  is  an  institution  to  which  the  poor  go  to  be  cured,  or 
helped,  or  to  have  their  condition  made  better.  "Betterment,"  meaning  improvement  or 
making  better,  is  not  obsolete,  although  infrequently  used.  One  definition  by  Webster  of 
"  Bettering  House  "  is  "  a  house  for  the  reformation  of  offenders,"  but  this  is  an  incorrect  defi- 
nition as  applied  to  the  almshouse.] 


MEDICAL  HISTORY  OF  THE  PHILADELPHIA  ALMSHOUSE.  5 

mission  for  the  Quarter  Master  [Deputy]  General  to  quarter  in 
the  institution  a  number  of  the  Continental  militia  who  were  very 
sick  with  dysentery.  This  was  strenuously  opposed  both  by  the 
managers  and  medical  attendants,  as  calculated  to  endanger  the 
health  of  the  house.  They  had  on  former  occasions  suffered 
greatly  from  the  prevalence  of  putrid  sore  throat  and  small-pox ; 
and  had  been  compelled  to  move  many  of  the  cases  to  private 
lodgings  in  order  to  stay  their  fatal  progress ;  and  in  justice  to 
the  helpless  and  infirm  inmates — most  of  whom  possessed  little 
ability  to  resist  disease — they  naturally  objected  to  the  intro- 
duction of  an  element  of  danger,  such  as  malignant  dysentery, 
the  scourge  of  camps  would  constitute.  As  all  military  govern- 
ments tend  to  despotism,  the  amplication  was  merely  to  maintain 
a  semblance  to  the  legitimate  forms  of  propriety.  This  is  quite 
natural  and  proper,  when  public  necessity  becomes  paramount  to 
personal  considerations,  and  accordingly  the  council  ordered 
Col.  Francis  Gurney,  on  the  23d  of  October,  to  take  military 
possession  of  the  almshouse  for  the  sick  soldiers.  No  alternative 
was  left  but  to  make  the  best  of  the  unpleasant  position  forced 
upon  them.  The  poor  were  transferred  to  the  west  building,  and 
the  soldiers-  were  placed  in  the  southeast  wing  of  the  House  of 
Employment,  arresting  entirely  the  industrial  operations  of  the 
establishment.  They  retained  possession  of  this  apartment  until 
the  British  took  possession  of  the  city  in  1777,  when  they  were 
removed. 

This  removal,  however,  in  no  way  relieved  the  managers  from 
embarrassment,  as  shortly  after,  in  the  month  of  October,  the  entire 
east  wing  was  appropriated  for  the  sick  belonging  to  the  King's 
troops  under  General  Howe.  For  fear  they  might  in  like  manner 
appropriate  the  west  wing  also,  the  managers  waited  on  Joseph 
Galloway,  to  secure  his  influence  with  the  general  to  prevent  an 
occurrence  which  must  entail  so  great  distress  on  the  poor — its 
inmates   at   this   time  being  of  the  most   helpless   description. 

Joseph  Galloway  was  a  lawyer  of  distinction  and  wealth,  speaker 
of  the  Provincial  Assembly.  In  our  struggle  he  took  the  royal 
side  of  the  question,  and  became,  under  the  sanction  of  the 
British  commander,  the  general  superintendent  of  the  city. 
When,  however,  the  cause  of  the  colonies  brightened,  and  Howe 
was  obliged  to  evacuate  the  city,  he  was  compelled  to  follow  his 
master,  his  estates  were  confiscated,  his  fortune  melted  away,  and 


G  MEDICAL  HISTORY  OF  THE  PHILADELPHIA  ALMSHOUSE. 

he  was  obliged  to  accept  a  secretaryship  to  the  commander-in- 
chief.  It  was  therefore  on  account  of  his  royal  proclivities  the 
managers  sought  his  aid.  They  were  referred  by  him  to  Dr. 
Stuart,  surgeon  general  of  the  British  Military  Hospital,  who 
promised,  unless  an  emergency  should  arise,  to  accede  to  their 
request. 

It  was  but  a  short  time  after  this,  in  November,  at  9  o'clock  at 
night,  when  the  poor  were  almost  destitute  of  food,  the  barrack 
master  called  on  two  of  the  managers  ordering  them  to  clear  the 
house  for  the  reception  of  the  King's  troops.  The  board  met  the 
next  morning,  and  after  short  deliberation,  refused  to  comply 
with  the  cruel  request.  On  hearing  their  decision,  the  British 
official  proceeded  at  once  to  remove  the  inmates — about  two  hun- 
dred in  number — of  miserable,  decrepid,  half  starved  creatures. 
As  they  would  soon  have  perished  exposed  to  the  rigors  of  a 
November  air,  the  managers  succeeded  in  securing  quarters  for 
them,  some  in  the  Freemasons' old  lodge,  still  standing  in  Filbert 
above  Eighth  street;  some  in  the  Friends  Meeting  House ;  and 
others  in  Carpenters'  Hall,  off  Chestnut,  above  Third  street,  where 
they  were  maintained  until  the  last  days  of  June,  1 778,  when  the 
invaders  having  left  the  city,  they  were  removed  back  to  their 
old  home.  The  exposure  and  deprivation  attending  their  eject- 
ment, was  followed  by  a  heavy  mortality,  as  only  eighty-two  of 
the  original  two  hundred  survived  to  re-enter  their  former 
quarters. 

In  1777  Drs.  Rush  and  Clarkson  resigned  their  posts,  and 
the  three  remaining  members  were  requested  by  the  board  of 
managers  either  to  occupy  their  term  of  service  or  to  choose 
substitutes,  the  former  of  which  they  concluded  to  do.  No  alter- 
ation in  this  arrangement  was  made  until  the  29th  of  April,  1779, 
when  a  proposition  was  made  by  Drs.  Glentworth,  Jackson  and 
Duffield  to  attend  the  sick  of  the  institution,  charging  only  for 
the  medicines  used  in  their  treatment. 

From  the  25th  of  March,  1780,  we  may  date  the  system  of  out 
door  medical  relief  as  a  part  of  the  benevolent  operations  of  the 
managers  of  the  poor.  In  order  that  such  aid  might  be  furnished, 
Drs.  Hutchison  and  Wilson  were  requested  to  attend  and  pre- 
scribe for  those  who,  though  not  inmates  of  the  institution,  were 
yet  dependent  on  its  resources  for  professional  aid.  From  this 
small  beginning,  in  which  two  gentlemen  were  able  to  meet  all 


MEDICAL  HISTORY  OF  THE  PHILADELPHIA  ALMSHOUSE.  7 

the  demands  of  the  city,  have  arisen  eleven  districts,  requiring 
twenty-four  physicians,  who  for  a  very  small  compensation  dis- 
pense an  amount  of  professional  relief  truly  wonderful.  In 
passing  over  the  records  of  this  department  it  is  pleasant  to  find 
that,  at  one  time  or  another,  almost  every  name  of  note  in  the 
ranks  of  our  profession  is  found  among  those  who  labored  in  this 
sphere  of  humble  usefulness,  and  no  doubt  not  a  few  of  them 
laid  the  foundation  of  their  future  reputation,  while  thus  engaged 
in  visiting  the  sick  poor  in  the  secluded  lanes  and  alleys  of  this 
metropolis.  No  man  can  long  labor  in  such  a  field  in  daily  con- 
tact with  a  class,  whose  sufferings  are  greatly  increased  by  the 
absence  of  so  much  which  serves  in  the  more  fortunate  to  allevi- 
ate the  pressure  of  disease,  without  feeling  all  the  sympathies  of 
his  heart  unlocked  and  becoming  a  wiser  and  a  better  man. 

On  the  7th  of  February,  1781,  Dr.  Bond,  who  it  seems  had  no 
connection  with  the  house  after  the  year  1779,  being  at  this  time 
medical  purveyor  of  the  United  States  Army,  applied  to  the 
managers  for  the  east  wing  of  the  building,  which  had  shortly 
before  been  occupied  by  the  board  of  war,  to  accommodate  a 
number  of  British  prisoners,  who  were  very  ill  at  that  time  in 
jail.  This  request  was  granted  by  his  agreeing,  on  behalf  of  the 
government,  to  pay  a  monthly  rent  of  one  hundred  dollars  hard 
money.  For  some  time  after  1781,  Dr.  Samuel  Duffield  seems  to 
have  been  the  only  physician  attached  to  the  institution,  giving 
his  attention,  under  contract  based  on  his  own  proposition,  to 
attend  to  all  the  inmates  and  find  the  necessary  medicines,  for 
the  sum  of  two  hundred  pounds  per  annum.  One  of  two  things 
is  evident,  either  the  doctor  was  not  fond  of  money  or  was  fond  of 
work. 

At  this  time  it  was  the  custom  to  have  the  venereal  cases  and 
the  violent  insane  treated  at  the  Pennsylvania  Hospital.  In 
regard  to  the  first,  it  was  deemed  necessary,  in  accordance  with 
the  current  medical  notions  on  the  subject,  to  subject  every  case 
to  a  mercurial  course,  carried  to  the  extent  of  salivation.  In  the 
Pennsylvania  Hospital  the  accommodations  for  this  were  greater 
and  more  complete  than  those  of  the  almshouse.  In  addition 
to  the  ordinary  expenses  of  board  and  nursing,  a  fee  was  always 
charged  against  the  almshouse  by  the  physician  under  whose 
care  the  case  had  been  treated.  There  is  a  record  of  two  guineas 
for  this  object  being  paid  to  Dr.  John  Morgan,  one  of  the  two 


8  MEDICAL  HISTORY  OF  THE  PHILADELPHIA  ALMSHOUSE. 

gentlemen  who  first  established  a  medical  school  in  America. 
In  1782  the  General  Assembly  passed  an  act  authorizing  the 
managers  to  bind  out  all  persons  treated  for  venereal  disease, 
until  the  expenses  were  liquidated  from  the  proceeds  of  their 
labor.  These  expenses,  it  is  presumed,  averaged  about  twenty- 
four  pounds,  from  that  amount  having  been  specified  on  the 
record,  as  the  sum  for  which  one  binding  had  been  made. 
Between  the  mortifying  annoyance  of  the  disease,  the  salivation 
of  the  doctors,  and  the  limited  apprenticeship,  the  worshipper  at 
the  shrine  of  Arenus  paid  dearly  for  his  whistle. 

In  1788  a  new  organization  of  the  medical  department  was 
made  by  the  election  of  Drs.  Samuel  Duffield,  Samuel.  P.  Griffits 
who  subsequently  became  professor  of  materia  medica  and  phar- 
macy in  the  Medical  College  of  Philadelphia ;  Dr.  Caspar  Wistar, 
afterwards  professor  of  chemistry  and  the  institutes  of  medicine, 
and  still  later  of  anatomy ;  Drs.  J.  R.  Rodgers,  Girardus  Clark- 
son,  Michael  Leib  and  John  Morris.  In  less  than  a  year  (in  April, 
1789)  Drs.  Morris  and  Griffits,  in  consequence  of  their  private 
business,  tendered  their  resignations.  Both  of  these  gentlemen 
were  popular,  and  although  their  official  connection  with  the 
house  had  been  short,  the  managers  in  accepting  their  resigna- 
tions acknowledged,  in  a  very  handsome  and  complimentary 
manner,  the  value  of  their  professional  services  to  the  house. 
The  same  month  in  which  Drs.  Morris  and  Griffits  withdrew  the 
medical  organization  was  reduced  to  six  members,  by  dropping 
Dr.  Rodgers  and  electing  Dr.  N.  B. Waters  and  Dr. William  Shippen, 
the  latter  the  founder  of  medical  teaching  in  this  country.  On 
the  29th  of  March,  1790,  the  managers  addressed  a  communica- 
tion to  these  physicians,  acknowledging  the  value  of  their  services 
to  the  poor,  and  begging  they  would  continue  their  several  offices 
the  coming  year.  This  letter  no  doubt  was  intended  to  be  anti- 
dotal, for  only  a  short  time  before  they  had  refused  a  very  reason- 
able request  of  the  medical  attendants,  which  will  receive  its 
proper  explanation  wThen  the  clinical  history  of  our  subject  is 
reached.  One  month  after  the  whole  body  of  physicians  resigned, 
the  institution  losing  the  best  medical  talent  in  the  city. 

Shortly  after  this  event,  Drs.  Duffield  and  Leib  solicited  an 
appointment  to  the  house,  and  after  their  election,  wrere  required 
to  become  the  purchasers  of  all  the  drugs  consumed  by  the  sick. 
The  increase  in  the  population  of  the  Almshouse,  together  with 


MEDICAL  HISTORY  OF  THE  PHILADELPHIA  ALMSHOUSE.  9 

the  private  engagements  of  these  gentlemen,  rendered  it  necessary 
for  them  to  ask  some  assistance,  for  which  object,  Dr.  Gumming, 
August  10,  1795,  was  appointed  assistant  visiting  physician 
without  salary. 

Whatever  may  be  thought  of  the  credulity  of  the  present 
generation,  it  is  no  less  clear  that  the  people  of  1796  were  not 
proof  against  charlatan  imposition.  Every  age  has  had  some 
crotchet  on  which  to  betray  mental  imbecility.  The  whale  must 
have  a  tub  with  which  to  amuse  itself.  At  the  period  above 
named,  it  was  Perkinism  or  the  cure  of  disease  by  metallic 
tractors.  The  most  extravagant  reports  of  extraordinary  cures 
affected  by  this  manipulation  had  been  bruited  abroad  in  advance 
of  the  doctor's  arrival  in  Philadelphia.  The  eyes  of  the  blind 
had  been  opened ;  the  ears  of  the  deaf  unstopped ;  the  lame  man 
made  to  leap  as  a  hart ;  and  in  fine,  a  universal  catholicon  for 
human  diseases  and  infirmities  had  at  length  been  discovered. 

On  the  27th  of  February  the  visiting  committee  of  the  house 
reported  having  witnessed  several  successful  operations  by  Dr. 
Perkins  with  his  metallic  points,  and  had  seen  the  grateful 
acknowledgments  of  many  others  who  had  been  the  subjects  of 
his  new  method  ;  that  the  hospital  contained  numerous  cases 
which  might  be  benefitted  by  his  skill,  and  proposed  that  George 
Davis,  one  of  the  members  of  the  board,  be  authorized  to  invite 
Dr.  Perkins  to  attend  the  institution  on  the  following  Wednesday, 
at  10  o'clock,  thus  giving  the  other  members  an  opportunity  of 
being  present  during  his  visit.  The  doctor  made  his  appearance 
on  the  appointed  day,  and  managed  so  successfully  to  close  the 
eyes  of  the  sage  managers  as  to  secure  from  them  the  purchase 
of  his  patent  for  the  benefit  of  the  hospital ;  and  this  house  to- 
day owns  the  exclusive  right  to  practice  in  Philadelphia  the  cure 
of  disease  by  metallic  points. 

Where  is  Perkinism  to-day?  That  gigantic  humbug,  which 
overrun  with  unparalleled  rapidity,  towns,  cities,  villages,  and 
rural  districts  at  home  and  abroad,  and  was  endorsed  by  three 
American  universities.  Gone  to  the  tomb  of  the  Capulets,  where 
every  other  ism,  system,  and  device  of  man,  not  resting  on  a  sub- 
stratum of  truth,  must  sooner  or  later  sink,  never  to  be  unburied 
except  by  the  pick  of  some  future  fossilist,  delving  among  the 
caput  mortuums  of  exploded  systems  for  specimens  of  human  folly, 
either  to  adorn  a  cabinet  or  point  the  shaft  of  ridicule.    That 


10  MEDICAL  HISTORY  OF  THE  PHILADELPHIA  ALMSHOUSE. 

Perkinism  could  not  have  proved  very  efficient  in  the  Philadel- 
phia Almshouse  may  be  inferred  from  the  fact  that  on  the  20th 
of  March  the  sick  had  become  so  numerous  as  to  require  an  addi- 
tional number  of  physicians  to  aid  Dr.  Duffield  and  his  assistant 
in  their  labors.  The  gentlemen  selected  by  the  board  were  Drs. 
Samuel  Clements,  Jr.,  Wm.  Boyce  and  Samuel  Cooper,  at  a  salary 
each  of  one  hundred  dollars  annually.  It  would  appear  Dr. 
Cooper  declined  the  appointment,  and  the  corps  remained  with- 
out any  substitute  being  elected.  They  were  required  to  visit  the 
hospital  three  times  a  week  ordinarily,  and  oftener  if  the  state  of 
the  sick  demanded  it ;  two  were  to  attend  together,  and  in  case  an 
operation  was  required  the  operator  was  to  be  selected  by  a 
majority  vote. 

In  the  fall  of  1797  Dr.  Pleasants  died,  and  on  the  23rd  of 
December  of  the  same  year  Drs.  John  Church  and  Thomas  C. 
James,  the  latter  subsequently  professor  of  obstetrics  in  the  Uni- 
versity of  Pennsylvania,  were  elected,  the  former  to  supply  the 
vacancy  occasioned  by  the  death,  and  the  other  in  the  place 
unoccupied  by  Dr.  Cooper. 

Until  1801,  there  were  no  changes  to  notice,  when  on  the  6th 
of  April  of  this  year,  Dr.  Boyce  tendered  his  resignation,  shortly 
after  which  Dr.  Elijah  Griffiths  was  elected  his  successor.  In 
August,  Dr.  Duffield,  who  seemed  to  be  a  necessary  appurtenance 
to  the  house,  having  been  connected  with  it  for  twenty-nine  years, 
was  dismissed  in  consequence  of  having  furnished  a  certificate 
admitting  a  patient  with  typhus  fever  into  the  institution.  At 
this  time  there  seems  to  have  been  very  close  police  exercised  by 
the  managers  over  admissions,  in  consequence  no  doubt,  of  the 
recent  epidemic  of  yellow  fever  which  had  desolated  so  many 
homes,  and  produced  such  wide-spread  distress  and  consternation 
in  the  community.  After  the  removal  of  Dr.  Duffield,  the  num- 
ber of  medical  attendants  was  increased  by  the  election,  on  Sep- 
tember 7,  1801,  of  Drs.  John  Proudfit,  Philip  Syng  Physick,  the 
father  of  American  surgery,  and  Charles  Caldwell,  familiar  to  the 
present  generation  of  medical  men  as  the  author  of  his  own 
biography;  a  man  unquestionably  of  remarkable  intellectual 
force,  combined,  however,  with  such  incongruous  elements  of 
character,  as  were  calculated  to  defeat  the  best  appointed  plans  of 
ambition.  These  gentlemen  were  to  receive  a  salary  of  twenty- 
five  pounds  per  annum. 


MEDICAL  HISTORY  OF  THE  PHILADELPHIA  ALMSHOUSE.  11 

In  1804  a  very  extraordinary  event  occurred  in  view  of  the  very 
amiable  nature  of  doctors  in  general.  This  was  a  quarrel  among 
the  physicians,  originating  mainly  in  a  private  difficulty  between 
Drs.  Caldwell  and  James.  The  dispute  grew  to  such  magnitude, 
that  the  managers,  as  the  shortest  way  to  establish  the  peace  of 
the  institution,  on  the  9th  of  Januar}'  proceeded  to  the  election  of 
a  new  board,  consisting  of  Drs.  Philip  Syng  Physick,  John  Church, 
Elijah  Griffiths,  John  Rush,  Thomas  C.  James,  Benjamin  Smith 
Barton  and  Samuel  Stewart;  each  of  whom  was  to  receive  the  old 
salary  of  twenty-five  pounds,  subject  to  all  reasonable  out-door 
calls.  Dr.  Rush  declined  the  appointment,  and  on  the  19th  of 
the  same  month,  Dr.  James  Reynolds  was  elected  to  take  his 
place. 

On  the  17th  of  January,  1805,  the  same  year  in  which  he  was 
elected  to  the  chair  of  surgery  in  the  University,  Dr.  Physick 
offered  his  resignation.  Very  soon  after  its  acceptance,  Dr.  James 
Hutchinson  was  appointed  his  successor.  The  latter  gentleman's 
name  is  associated  with  a  modification  of  the  Desault  splint  for 
fractures  of  the  thigh.  His  service  was  of  short  duration,  his 
resignation  being  recorded  three  months  after  the  announcement 
of  his  election.  During  this  year  a  difficulty  occurred  between 
the  managers  and  Dr.  Barton,  in  consequence  of  the  latter 
declining  to  attend  out-door  patients.  Their  views  being  irrecon- 
cilable, the  doctor  was  dismissed,  and  to  supply  the  two  vacancies 
now  existing,  Drs.  J.  Cathrall  and  Peter  Miller  were  elected  by 
the  board. 

It  was  also  during  this  year  Dr.  Church  died.  His  place  was 
occupied  by  the  brilliant  but  short-lived  John  Syng  Dorsey,  who 
in  his  brief  career  of  professional  life,  occupied  no  less  than  three 
prominent  positions  in  the  medical  department  of  the  University 
of  Pennsylvania — first,  as  an  adjunct  to  Physick ;  then  as  a  suc- 
cessor to  Chapman  on  materia  medica,  and  last,  as  a  successor  to 
Wistar  on  anatomy.  The  next  change  was  produced  by  the  death 
of  Dr.  Reynolds  in  1807.  After  this  event  an  additional  phy- 
sician was  added  to  the  corps  by  the  election  of  Dr.  Nathaniel 
Chapman  to  supply  the  vacancy  occasioned  by  the  death  of  Dr. 
Reynolds,  and  Dr.  Joseph  Parrish  to  make  up  the  complement  of 
the  staff. 

On  the  17th  of  November,  1809,  a  resolution  was  introduced 
and  adopted  by  the  managers,  constituting  the  medical  officers  of 


12  MEDICAL  HISTORY  0E  THE  PHILADELPHIA  ALMSHOUSE. 

the  Almshouse  a  medical  board.  They  were  to  meet  the  first 
Monday  of  every  month,  at  4  o'clock,  p.  m.,  and  report  rules  for 
the  government  of  the  hospital  department. 

The  following  year,  1810,  furnishes  us  with  the  first  instance, 
so  far  as  I  know,  of  a  hospital  in  this  country  receiving  a  female 
resident  physician.  On  the  first  of  July,  a  Mrs.  Lavender  made 
application  to  be  admitted  to  the  institution  as  an  assistant  mid- 
wife, in  order  the  better  to  perfect  her  education.  Such  a  charm- 
ing name  as  "  Lavender"  so  overcame  the  physical  senses  of  the 
members  of  the  board,  that  they  lost  their  intellectual  senses  and 
granted  her  petition.  During  my  term  of  service  in  the  winter 
of  1856,  several  women  from  the  Female  Medical  College  of  this 
city  were  furnished  with  tickets  to  the  clinical  lectures  without 
my  knowledge.  You  may  imagine  my  astonishment,  when  enter- 
ing the  lecture-room  to  discharge  the  duties  of  the  hour,  I  saw 
seated  on  one  side  of  the  amphitheatre  a  number  of  these  mis- 
guided creatures.  I  had  selected  for  the  instruction  of  the  class 
that  morning  a  series  of  cases  all  illustrating  some  disease  of  the 
genital  organs ;  and  as  it  was  now  too  late  to  recede,  I  proceeded 
to  operate  for  phymosis,  and  to  exhibit  and  treat  some  blooming 
specimens  of  chancre.  Notwithstanding  there  was  a  large 
number  of  male  students  present,  and  the  personal  exposure 
necessary  for  the  conduct  of  the  clinic,  they  never  betrayed  the 
slightest  evidence  of  shame,  but  sat  with  the  imperturbable  indiffer- 
ence of  primeval  innocence.  This  I  suppose  some  would  consider 
praiseworthy  and  philosophical,  but  I  confess  it  exhibited  to  me 
a  perversion  of  character  utterly  below  my  preconceived  views 
ever  entertained  of  strong-minded  women.  The  occurrence  was 
never  repeated,  as  I  at  once  addressed  a  letter  to  the  board,  when 
their  money  was  returned  and  admittance  refused. 

Two  vacancies  occurred  in  1810,  one  by  the  withdrawal  of  Dr. 
Griffits  and  the  other  by  the  death  of  Dr.  Stewart.  To  supply 
these,  Drs.  Stewart  and  Joseph  Klapp  were  elected.  On  the  2d 
of  September,  1811,  Dr.  Dorsey  tendered  his  resignation,  and  on 
the  9th  of  the  same  month,  was  succeeded  by  Dr.  Thomas 
Hewson. 

The  service  of  various  gentlemen  now  connected  with  the 
house  was  so  arranged  that  one  portion  were  to  attend  to  surgical 
and  the  other  to  medical  and  obstetrical  cases.  The  surgical  staff 
consisted  of  Drs.  Cathrall,  Miller  and   Parrish ;    the  medical,  of 


MEDICAL  HISTORY  OF  THE  PHILADELPHIA  ALMSHOUSE.  13 

Drs.  Chapman,  Stewart  and  Hewson.  Between  the  managers  of 
the  Philadelphia  Almshouse  and  Pennsylvania  Hospital  there 
existed,  at  this  time,  much  unamiable  temper  as  well  as  jealousy. 
Both  were  anxious  to  secure  the  patronage  of  medical  students, 
and  therefore  stood  in  the  attitude  of  rivals.  To  such  a  degree 
were  the  minds  of  the  former  influenced  by  these  feelings  that 
they  were  led  to  pass  a  resolution  calculated  to  act  prejudicial 
rather  than  favorable  to  the  prosperity  of  their  institution.  This 
resolution  rendered  all  the  physicians  and  surgeons  holding 
places  in  the  Pennsylvania  Hospital  ineligible  to  an  election  in 
the  almshouse.  In  1813  this  measure  was  reaffirmed,  but  from 
being  associated  with  certain  other  matters  drew  out  an  opposi- 
tion, the  influence  of  which  became  sufficiently  potential  to  secure 
its  repeal.  In  1814  Dr.  Dorsey  again  became  a  member  of  the 
medical  board,  and  it  was  to  his  personal  influence  that  the  meri- 
torious poor,  recovering  from  disease,  were  indebted  for  the  house- 
carriage,  purchased  by  the  managers  to  afford  to  convalescents 
the  benefit  of  exercise  and  fresh  air. 

In  1815,  in  consequence  of  the  managers  assuming  to  regulate 
the  term  of  service  of  the  medical  board  in  a  manner  not  agree- 
able to  its  members,  Dr.  Chapman  resigned,  and  was  succeeded 
on  the  8th  of  May  by  Dr.  Joseph  Klapp.  The  obstetrical  depart- 
ment having  been  placed  exclusively  under  the  control  of  Dr. 
James,  its  duties  necessarily  absorbed  more  time  than  was  com- 
patible with  the  proper  discharge  of  other  engagements,  and  at 
his  request,  on  the  2nd  of  November,  1818,  Dr.  John  Moore  was 
elected  associate  obstetrician  to  the  house. 

In  1818  Dr.  Dorsey,  after  a  few  days  illness,  terminated  his 
mortal  career  in  the  35th  year  of  his  age.  By  the  death  of  Dorsey 
the  profession  lost  one  of  its  noblest  ornaments ;  the  institution  a 
man  who  reflected  honor  on  its  hospital ;  the  poor  a  compassion- 
ate and  devoted  friend.  The  place  thus  made  vacant  by  the 
hand  of  death  was  filled  on  the  20th  of  November  by  Dr.  Joseph 
Hartshorne,  then  among  the  leading  practitioners  of  Philadelphia. 
Two  sons  of  Dr.  Hartshorne,  enjoying  deservedly  high  reputations 
as  men  of  culture  and  position,  perpetuate  the  eminence  of  their 
paternal  ancestor  in  our  midst  to-day.  Dr.  Hartshorne's  connec- 
tion with  the  house  continued  until  February  28,  1820,  when  an 
extensive  and  laborious  practice  compelled  him  to  withdraw. 
On  the  same  day  in  which  his  resignation  was  accepted  Dr.  John 


14  MEDICAL  HISTORY  OF  THE  PHILADELPHIA  ALMSHOUSE. 

Rhea  Barton  was  elected,  one  of  the  most  accomplished  and 
ingenious  surgeons  of  this  city,  although  not  now,  it  is  to  be 
regretted,  engaged  in  the  active  duties  of  his  profession. 

It  was  during  this  year  Drj  William  Swaim,  the  manufacturer 
of  a  panacea  which  had  acquired  considerable  notoriety,  was 
allowed  the  privilege  of  administering  his  patent  medicine  to 
several  patients  suffering  from  specific  ulcers,  and  with  a  degree 
of  success  which  I  believe  secured  unfortunately  the  endorsement 
of  names  high  in  the  ranks  of  the  profession.  The  large  fortune 
amassed  by  the  patentee  of  this  medicine  may  be  said,  in  a 
measure,  to  have  resulted  from  the  circumstances  attending  this 
experiment. 

In  February,  1821,  Dr.  Moore  resigned,  and  Dr.  Henry  Neill  was 
elected,  first  as  assistant  obstetrician  to  Dr.  James,  and  afterwards 
in  March  to  equal  rank  with  his  colleague.  Very  shortly  after 
Dr.  James,  whose  service  to  this  charity  extended  over  twenty-five 
years,  declined  any  longer  to  discharge  the  duties  of  obstetrician, 
and  on  the  5th  of  March,  1821,  Dr.  Nathan  Shoemaker  assumed 
the  labors  of  this  department.  This  year  the  addition  of  two 
surgeons  and  two  physicians  to  the  medical  board  was  sanctioned 
by  the  managers,  which  in  connection  with  the  resignations  of 
Drs.  Parrish  and  Rush,  the  same  year,  left  four  places  to  be  sup- 
plied, to  which  Drs.  William  Gibson,  George  McClellan,  Samuel 
Colhoun,  and  Wm.  P.  C.  Barton  were  chosen — all  men  holding 
high  rank  among  the  magnates  of  American  surgery  and  medicine. 

During  1822  the  leaven  of  discord  again  commenced  working 
among  the  members  of  the  medical  corps,  and  finally  attained 
such  proportions  as  to  demand  the  interference  of  the  managers, 
who  passed  a  resolution  to  dispense  with  the  services  of  the  board. 
This  occurred  on  the  12th  of  August,  and  on  the  26th  they  pro- 
ceeded to  select  a  new  body,  which  consisted  of  Drs.  Samuel 
Jackson,  Joseph  Klapp,  John  K.  Mitchell,  and  Richard  Harlan, 
to  serve  as  physicians;  Drs.  John  Rhea  Barton,  William  Gibson, 
William  E.  Horner,  and  J.  V.  0.  Lawrence  as  surgeons,  and  Drs. 
Henry  Neill  and  Nathan  Shoemaker  as  obstetricians.  Dr.  Klapp 
only  retained  his  connection  with  the  house  until  September, 
when  he  was  succeeded  by  Dr.  Nathaniel  Chapman. 

Dr.  Lawrence,  who  was  one  of  the  most  indefatigable  workers, 
especially  in  morbid  anatomy,  was  attacked  with  the  prevailing 
fever  in  1822,  notwithstanding  which  he  very  imprudently  con- 


MEDICAL  HISTORY  OF  THE  PHILADELPHIA  ALMSHOUSE.  15 

tinued  to  discharge  his  professional  labors,  until  after  an  opera- 
tion in  the  institution  he  found  himself  utterly  exhausted  and 
was  taken  home  in  the  carriage  of  a  friend,  and  a  few  days  after 
expired.  After  the  death  of  Dr.  Lawrence,  Dr.  Harlan  was  trans- 
ferred to  the  surgical  staff,  and  Dr.  Hugh  L.  Hodge  was  elected  to 
the  vacancy  thus  created  in  the  medical  department. 

In  1827  Dr.  Shoemaker  declined  acting  as  obstetrician,  and  on 
the  3d  of  September  was  succeeded  by  Dr.  C.  Lukens.  This  year 
was  indeed  rather  remarkable  for  changes  in  the  medical  organ- 
ization. Drs.  Mitchell  and  Lukens  resigned,  and  were  replaced 
by  Dr.  Samuel  George  Morton,  the  distinguished  naturalist,  and 
by  Dr.  B.  Ellis.  The  latter  gentleman  retained  his  connection  with 
the  Almshouse  until  1831,  when  he  was  removed  by  death,  and 
on  the  2d  of  May,  of  the  same  year,  Dr.  Beattie  was  selected  to 
fill  the  vacancy. 

In  March,  1828,  an  act  had  passed  the  Legislature  of  Pennsyl- 
vania providing  for  the  erection  of  a  new  almshouse  and  the  sale 
of  the  old  one.  It  further  provided  for  the  erection  of  a  hospital, 
not  to  be  erected  beyond  Schuylkill  Eighth,  now  called  Fifteenth 
street.  The  medical  board  pressed  the  building  of  this  hospital 
strongly  on  the  managers,  believing  its  removal  to  the  west  side 
of  the  Schuylkill  would  destroy  its  value  as  a  clinical  school. 
There  efforts,  however,  proved  unavailing,  as  the  enterprise  was 
calculated  to  involve  a  very  large  outlay  of  money. 

On  the  30th  of  April,  1832,  Dr.  Chapman  gave  up  his  position 
and  was  succeeded  by  Dr.  Jacob  Randolph.  Up  to  this  time  Dr. 
Horner  had  been  serving  as  physician,  but  when  Dr.  Randolph 
became  a  member  of  the  board,  they,  by  mutual  agreement, 
exchanged  positions,  surgery,  being  more  in  harmony  with  the 
tastes  of  the  former.  Almost  three  years  elapsed  before  another 
change  is  recorded,  or  until  March  16,  1835,  when  Dr.  Neill 
resigned  and  Dr.  Caspar  Wistar  Pennock  was  elected.  Dr.  Pen- 
nock  wTas  a  highly  accomplished  physician,  and  this  hospital  fur- 
nished him  a  field  for  those  observations  on  the  heart,  which  were 
afterwards  presented  in  a  volume  to  the  medical  world.  An 
earnest  and  untiring  worker,  he  was  soon  laid  aside  from  the 
activities  of  the  profession  he  dearly  loved,  and  although  still 
living,  is  the  victim  of  a  hopeless  paralysis. 

On  the  13th  of  October,  1835,  Dr.  William  H.  Gerhard  was 
elected  one  of  the  physicians.     The  doctor  had  enjoyed  as  a  resi- 


16  MEDICAL  HISTORY  OF  THE  PHILADELPHIA  ALMSHOUSE. 

dent  pupil  the  practice  of  the  house  for  many  years,  namely,  in 
1828-29-30-31.  It  was  while  acting  in  this  capacity  in  1829  that 
he  performed  those  experiments  on  the  endermic  application  of 
medicines,  which  were  made  the  subject  of  a  thesis,  and  which 
have  been  translated  into  almost  every  language.  It  was  here  he 
commenced  the  cultivation  of  physical  exploration  as  a  means  of 
diagnosis,  and  which  entitles  him  to  be  regarded  as  the  father  of 
auscultation  and  percussion  in  America.  It  was  here  in  1836 
that  he  made  those  careful  investigations  of  the  study  of  intes- 
tinal lesions,  which  clearly  established  the  distinction  between 
typhus  and  typhoid  fever.*  And  it  was  here  by  changing  the 
stereotyped  method  of  treating  cases  of  mania-potu,  lie  was  instru- 
mental in  diminishing  the  mortality  fifty  per  cent. 

This  year,  Mr.  Isaac  Collins,  a  member  of  the  board  of  guar- 
dians, offered  a  resolution  to  alter  the  medical  organization  by 
establishing  a  chief  resident  physician  to  reside  permanently  in 
the  house.  Although  it  was  subsequently  reported  as  inexpedient, 
yet  it  may  be  regarded  as  the  germ  of  a  subject  wdiich  has  at 
different  times  produced  no  small  amount  of  agitation.  On  the 
7th  day  of  October,  1835,  both  Drs.  Hodge  and  Morton  resigned. 
These  vacancies  were  supplied  by  the  election  of  Dr.  Joseph  Pan- 
coast,  the  present  eminent  professor  of  anatomy  in  Jefferson 
Medical  College,  and  Dr.  William  Ashmead. 

On  the  28th  of  December  of  this  year,  Drs.  Gerhard  and  Pen- 
/  nock  suggested  to  the  guardians  the  propriety  of  designating  the 
hospital  department  by  some  specific  name,  as  that  of  almshouse 
could  not  technically  be  regarded  in  the  sense  of  a  hospital. 
When  the  subject  came  up  regularly  before  the  board,  it  was 
moved  by  a  member,  Mr.  Hansel,  that  it  should  be  styled  the 
Philadelphia  Hospital.  This  received  the  sanction  of  the  majority 
vote,  and  has  been  known  under  that  name  ever  since.  In  the 
month  of  February,  1837,  Dr.  Pancoast  wTas  transferred,  at  his 
request,  to  the  surgical  staff,  a  vacanc}^  having  occurred  by  the 
withdrawal  of  Dr.  Randolph.  To  supply  Dr.  Pancoast's  vacancy 
in  the  medical  department,  Dr.  N.  Stuardson  became  a  member 
of  the  board.  In  1837,  Dr.  Beattie,  one  of  the  obstetricians, 
resigned,  and  Dr.  William  D.  Brinckle  became  a  member  of  the 
board.  Dr.  Stuardson's  connection  with  the  house  did  not  extend 
much  over  one  year,  or  until  May,  1838,  at  which  time  Dr.  Robley 

*  These  papers  may  be  found  in  the  "American  Medical  Journal  of  Medical  Sciences"  for 
the  year  1837. 


MEDICAL  HISTORY  OF  THE  PHILADELPHIA  ALMSHOUSE.  17 

Dunglison,  the  present  distinguished  professor  of  physiology  in 
the  Jefferson  Medical  College  was  elected.  The  year  just  passed 
was  remarkable  for  one  of  those  visitations  of  folly  and  ignorance 
which  seem  periodically  to  sweep  over  the  country ;  providentially 
I  believe,  designed  to  distinguish  the  wise  from  the  fools.  In  the 
instance  referred  to  it  was  animal  magnetism  ;  and,  of  course,  if 
a  patent  medicine  was  to  be  tested,  or  any  charlatan  maneuvre  to 
to  be  practised,  the  Philadelphia  Hospital  was  a  field  in  which 
the  trial  was  to  be  made,  like  a  barber's  head  everlastingly  pulled 
for  stray  hairs  to  determine  the  cutting  qualities  of  his  instrument. 
The  resident  pupils,  among  others,  assiduously  labored  in.  the 
manipulation  of  the  patients  to  determine  its  value,  until  the 
guardians,  for  fear  the  remedy  should  prove  too  powerful  for  the 
constitutions  of  the  poor,  passed  a  resolution  on  the  20th  of  June, 
1837,  disallowing  all  further  operations. 

In  December,  1838,  two  vacancies  were  made  in  the  board  by 
the  withdrawal  of  Drs.  Ash  mead  and  Harlan,  to  which  Dr. 
Charles  Bell  Gibson,  now  professor  of  surgery  in  a  Virginia 
Medical  College,  and  Dr.  Edward  Peace,  late  surgeon  to  the 
Pennsylvania  Hospital,  were  elected.  The  next  change  was 
the  resignation  of  Dr.  Brinckle,  in  May,  1839,  and  the  appointment 
of  Dr.  Robert  M.  Huston  to  fill  his  place.  Dr.  Gibson  declining 
to  serve  longer  than  the  fall  of  1840,  Dr.  James  McClintock 
became  one  of  the  obstetricians  of  the  house.  In  1841,  Dr. 
Peace's  connection  with  the  medical  board  terminated,  and  on  the 
3d  of  May  in  the  same  year,  Dr.  Ashmead  again  became  con- 
nected with  the  hospital.  In  the  following  August,  Dr.  McClintock 
removed  from  Philadelphia,  and  Dr.  William  H.  Gillingham 
became  one  of  the  obstetricians  of  the  hospital. 

In  April,  1843,  Dr.  Meredith  Clymer  was  elected  one  of  the 
officers  of  the  house,  and  was,  I  believe,  the  last  member  of  the 
old  visiting  board  of  phj^sicians. 

The  30th  of  June,  1845,  is  somewhat  memorable  in  consequence 
of  the  culmination  of  a  trouble  which  had  been  developing  for 
some  time.  The  resident  physicians  were  boarded  at  the  table 
of  the  steward,  where,  as  I  understand,  in  consequence  of  the 
want  of  due  formality  and  decorum  in  the  destruction  of  an 
unfortunate  cockroach,  which  had  rashly  taken  a  near  cut  across 
the  table  instead  of  going  around,  these  gentlemen  became  indig- 
nant, and  demanded  of  the  managers  to  be  transferred  to  the 

2 


18  MEDICAL  HISTORY  OF  THE  PHILADELPHIA  ALMSHOUSE. 

table  of  the  matron.  ,  Their  refusal  to  comply  with  this  request 
determined  a  unanimous  resignation,  leaving  the  hospital  unpro- 
vided with  any  medical  assistance.  The  evening  of  that  day 
Drs.  Horner  and  Clymer  attended  and  prescribed  for  the  sick. 
Here  was  a  casus  belli,  and  the  managers  promptly  passed  a  reso- 
lution of  dismissal. 

With  the  hope  of  adjusting  these  differences  and  bringing 
about  a  partial  reconciliation,  a  joint  meeting  was  called  for  July 
2,  at  which  Drs.  Jackson,  Horner,  Glymer,  Gillingham  and  Pan- 
coast  attended,  representing,  as  a  committee,  the  medical  board. 
Dr.  Jackson,  who  seems  to  have  been  the  advocate  in  the  case, 
spoke  in  behalf  of  the  committee,  urging  the  managers  to  allow 
the  residents  to  remain,  at  least  until  their  places  could  be 
properly  supplied,  declining  to  pass  any  censure  or  interfere  in 
any  matter  of  personal  conflict  between  the  residents  and  guar- 
dians, as  foreign  altogether  to  their  legitimate  jurisdiction.  The 
guardians,  however,  were  inexorable,  and  refused  to  recede  from 
their  vote  of  dismissal,  thus  forever  closing  the  door  of  compro- 
mise. The  seceders,  after  retiring,  availed  themselves  of  the  col- 
umns of  the  Ledger  newspaper,  in  which  there  appeared  a  card 
betraying,  to  say  the  least  of  it,  a  good  deal  of  youthful  indis- 
cretion. 

On  the  same  day  of  this  meeting  Mr.  Flanagan  offered  'the 
following  resolution :  "Resolved,  That  the  hospital  committee  be 
requested  to  look  into  the  expediency  of  reorganizing  the  medical 
department  of  the  house,  and  report  to  this  board."  On  the  21st 
of  July  the  report  was  made,  which,  after  going  over  the  ground 
of  the  trouble,  recommended  the  abolishment  of  the  medical 
board  and  the  substitution  of  a  chief  resident  and  assistant  resi- 
dent physician,  and  two  consulting  physicians  and  surgeons.  On 
the  15th  of  September  the  report  was  taken  up  and  passed,  modi- 
fied as  follows :  "After  the  1st  of  October,  1845,  there  shall  be 
one  chief  resident  physician,  with  a  salary  of  $1,800  per  annum; 
one  consulting  surgeon,  one  consulting  physician,  and  one  con- 
sulting accoucheur,  each  at  a  salary  of  one  hundred  dollars  a 
year." 

What  great  results  proceed  from  small  and  unlikely  causes. 
Who  would  have  ever  thought  that  the  official  existence  of  a 
medical  board,  composed  of  the  ablest  men  in  their  various  depart- 


MEDICAL  HISTORY  OF  THE  PHILADELPHIA.   ALMSHOUSE.  19 

ments  on  the  continent,  could  have  depended  on  the  life  of  a 
contemptible  cockroach.  In  this  manner  the  doors  of  the  Phila- 
delphia Hospital,  as  a  school  of  instruction,  were  sealed  for  nine 
years. 


THE  ADMINISTRATION  UNDER  A  CHIEF  RESIDENT  OFFICER. 

On  the  6th  of  October,  1845,  the  election  took  place  under  the 
new  organization,  by  which  Dr.  H.  S.  Patterson  was  chosen  phy- 
sician-in-chief; William  Byrd  Page,  consulting  surgeon;  Meredith 
Clymer,  consulting  physician,  and  N.  D.  Benedict,  consulting 
accoucheur.  Three  months  had  not  elapsed  before  the  board 
complained  of  the  interests  of  the  hospital  being  neglected.  Dr. 
Patterson  at  that  time  held  a  professorship  in  the  Pennsylvania 
Medical  College,  and  they  deemed  this  incompatible  with  his 
present  post.  On  the  9th  of  November  he  resigned.  Dr.  N.  D. 
Benedict  was  elected  his  successor,  and  the  office  of  consulting 
accoucheur  abolished. 

In  January,  1818,  the  annual  salary  of  one  hundred  dollars, 
which  had  been  appropriated  to  each  of  the  consulting  officers, 
was  changed,  directing  five  dollars  to  be  paid  for  each  consulta- 
tion, and  such  visits  to  be  ordered  in  cases  of  absolute  necessity. 

In  February,  1850,  Dr.  Benedict  resigned,  after  which,  on  the 
18th  of  this  month,  Dr.  Haines  became  chief  resident,  which 
position  he  continued  to  hold  until  the  11th  of  February,  1853, 
when,  exchanging  his  profession  for  another  and  more  lucrative 
calling,  he  removed  from  the  city  leaving  his  place  vacant,  and 
was  succeeded  by  Dr.  J.  D.  Stewart.  In  July,  1853,  an  effort  was 
made  to  abolish  this  office  and  return  to  the  old  system ;  and 
although  it  did  not  prove  successful  as  regards  the  chief  resident 
of  the  hospital,  yet  it  did  prevail  in  a  degree  by  dispensing  with 
the  assistant  resident  of  the  lunatic  asylum. 

Dr.  Stewart's  connection  with  the -house  was  very  short.  His 
health  had  been  for  some  time  gradually  failing  under  the  pro- 
gress of  an  organic  affection  of  the  liver,  which  terminated  his 
life  in  April,  1854.  The  office  of  chief  resident  was  now  tempo- 
rarily discharged  by  Dr.  R.  T.  Coleman,  then  an  interne  of  the 
house,  or  until  the  1st  of  May,  at  which  time  Dr.  Archibald  B. 
Campbell  was  elected. 


20  MEDICAL  HISTORY  OF  THE  PHILADELPHIA  ALMSHOUSE. 

CLINICAL  INSTRUCTION. 

To  Dr.  Thomas  Bond  belongs  the  honor  of  inaugurating  clinical 
teaching  in  this  country,  while  physician  to  the  Pennsylvania 
Hospital,  as  early  as  1766 ;  but  for  the  Philadelphia  Almshouse 
we  may  claim  the  establishment  of  the  first  obstetrical  clinic. 
Students  of  good  character  were  allowed  to  attend  cases  of  labor, 
'and  various  stages  of  the  process  were  explained  to  them  by  Dr. 
Bond  or  Evans,  under  whose  personal  direction  these  instructions 
were  conducted  as  early  as  1770,  and  in  all  probability  much 
earlier,  as  may  be  inferred  from  the  phraseology  of  the  minutes 
touching  the  subject.  In  1772,  the  managers  were  solicited  to 
extend  the  medical  conveniences  of  the  house  for  the  better 
accommodation  of  students,  increased  numbers  of  whom  began  to 
be  attracted  to  Philadelphia  from  the  growing  reputation  of  the 
medical  school.  A  part  of  this  plan  was  to  increase  the  medical 
officers ;  and  at  this  date  some  of  the  first  names  in  the  profession 
were  associated  with  the  enterprise,  such  as  Huhn,  Rush  and 
Clarkson ;  but  the  records  are  too  meagre  to  furnish  any  details 
of  the  manner  in  which  these  public  instructions  were  conducted. 

It  was  then  the  most  extensive  hospital  on  the  continent,  con- 
taining about  three  hundred  and  fifty  persons,  and  must  unques- 
tionably have  contained  much  disease  of  an  interesting  and 
instructive  character.  Where  the  governing  power  of  an  institu- 
tion is  constantly  undergoing  change,  little  stability  and  per- 
manence can  be  expected  in  any  plan  or  system  of  education. 
Either  the  hostility  of  some  of  the  managers,  or  more  probably 
the  unsettled  state  of  affairs  consequent  on  the  revolutionary 
struggle,  interrupted  the  medical  instruction  for  some  time  before 
1778,  nor  is  there  any  evidence  that  clinical  lectures  were  deliv- 
ered in  the  Pennsylvania  Hospital  for  several  years  subsequent 
to  1771,  where  Dr.  Bond  was  in  the  habit  of  delivering  a  course 
as  part  of  the  instruction  of  the  medical  college. 

In  November,  1778,  the  subject  was  revived  by  the  students 
present  in  the  city.  They  presented  a  formal  application  to  the 
physicians  of  the  almshouse  for  permission  to  witness  the  prac- 
tice in  that  institution.  Drs.  Rogers  and  Leib  waited  on  the  board 
of  managers  in  their  behalf,  ond  pressed  the  importance  of  such  a 
measure  with  great  earnestness.  On  the  17th  of  November,  the 
subject  came  up  formally  before  the  board,  and  although  there 


MEDICAL  HISTORY  OF  THE  PHILADELPHIA  ALMSHOUSE.  21 

were  several  altogether  favorable  to  the  proposition,  a  majority  of 
the  votes  were  recorded  in  the  negative.  Immediately  after,  the 
physicians  renewed  their  application  and  solicited  a  personal  con- 
ference with  the  managers.  A  second  meeting  in  consequence 
took  place,  at  which  the  advantages  of  hospital  instruction  to  the 
profession  and  the  community  were  presented  with  renewed 
cogency  and  sincerity.  They  begged  a  reconsideration  of  the  subject, 
asking  the  body  of  managers  to  concede  at  least  a  probationary 
trial,  and  volunteering  a  personal  responsibility  for  the  good  con- 
duct of  the  young  men  in  attendance.  .  The  plea  was  not  unsuc- 
cessful ;  the  vote  was  reconsidered,  and  the  house  opened,  by  the 
majority  of  one  vote,  for  clinical  instruction. 

Until  1789,  hospital  teaching  continued  to  be  conducted  under 
great  embarrassment,  partly  on  account  of  the  war  and  partly 
from  the  opposition  of  the  hostile  element  in  the  board,  so  that 
while  we  cannot  say  it  was  formally  abolished,  "  de  jure,"  yet  it 
was  almost  impracticable,  "  de  facto." 

On  the  5th  of  May,  1789,  the  physicians  elected  sent  a  commu- 
nication to  the  board,  in  which  they  took  occasion  to  say,  "that 
inasmuch  as  they  furnished  their  services  to  the  institution  with- 
out expense  to  the  managers,  they  ought  to  have  such  facilities 
offered  as  would  make  their  practice  useful  to  the  public."  Their 
meaning  not  being  sufficiently  explicit  the  board  asked  an  expla- 
nation, which  they  received  the  4th  of  July,  and  certainly  left  as 
little  room  for  misunderstanding  as'  did  the  immortal  document 
associated  with  this  day.  On  the  29th,  the  managers  framed  a 
communication  for  the  medical  attendants,  full  of  compliment 
acknowledging  their  valuable  services  to  the  sick,  and  assuring 
these  gentlemen  that  they  will  ever  endeavor  to  make  their  duties  as 
agreeable  as  will  be  consistent  with  the  good  order  of  the  house,  and 
the  delicacy  due  to  the  patients  under  their  charge.  One  month 
after,  all  the  physicians  withdrew  from  the  institution.  For  six 
years  the  subject  was  allowed  to  slumber,  until  October,  1795, 
when  Dr.  Gumming,  who  had  been  appointed  one  of  the  visiting- 
physicians,  ventured  to  approach  this  hitherto  imperturbable 
body  with  a  request  to  be  allowed  the  privilege  of  introducing 
his  private  students  to  the  wards  on  the  days  of  his  official  visits. 
The  proposition  was  promptly  rejected  on  the  ground  of  such 
publicity  being  calculated  to  do  harm  to  the  sick.  In  1803,  Drs. 
James  and  Church  proposed  to  attend  the  lying-in  wards,  on  con- 


22  MEDICAL  HISTORY  OF  THE  PHILADELPHIA  ALMSHOUSE. 

dition  they  should  be  allowed  to  have  one  private  pupil  present  at 
each  case  of  labor.  The  application  was  granted,  and  much  in- 
valuable instruction  was  communicated  in  this  responsible  depart- 
ment of  medicine.  My  father,  who  was  a  pupil  of  Dr.  James, 
was  among  the  number  who  enjoyed  this  privilege.  The  same 
year,  on  the  23d  of  March,  Dr.  Caldwell  was  allowed  to  introduce 
and  instruct  a  select  class  of  twenty — afterwards  forty  students — 
during  his  stated  visits  to  the  medical  wards,  on  condition  of  his 
becoming  responsible  for  their  good  deportment.  Students  at 
this  time  were  regarded  with  no  small  amount  of  suspicion ;  and 
even  at  the  present  there  are  not  wanting  many  persons  who 
entertain  toward  them  a  good  deal  of  reserve  and  distrust.  It  is  a 
shocking  thing,  gentlemen,  to  cut  up  dead  people ;  and  one  might 
suppose  from  the  horror  with  which  some  people  shun  you,  that 
students  were  in  the  habit  of  eating  them. 

In  November,  1806,  through  the  efforts  of  Drs.  James  and 
Church,  the  managers  conceded  the  privilege  to  deliver  clinical 
lectures  to  a  class  of  students  twice  a  week  in  the  green  or  dead 
house,  during  the  winter  season.  Shortly  after,  Dr.  Barton  was 
permitted  to  give  instructions  to  his  class  on  his  days  of  regular 
attendance  at  the  house.  Every  successive  year  now  removed 
more  and  more  prejudices  which  had  so  long  operated  against  the 
admission  of  medical  students.  The  managers  were  seized  with 
an  active  desire  to  pr  anote  and  foster  a  system  which  contributed 
so  largely  towards  laying  a  solid  foundation  of  medical  useful- 
ness. Hence,  in  1806,  the  buildings  for  the  accommodation  of 
the  sick  and  poor  being  inadequate  for  their  proper  comfort,  the 
administrative  part  of  the  board  addressed  the  legislature  by 
petition,  soliciting  aid  to  enlarge  the  house. 

In  presenting  their  prayer,  they  rested  their  claims  on  the  state 
alone  in  the  fact  that  the  charities  of  the  institution  had  not  been 
confined  to  the  city  and  county  of  Philadelphia  alone,  one-fifth 
of  the  inmates  being  from  other  parts  of  the  commonwealth ; 
that  the  Pennsylvania  Hospital,  rich  in  estates,  had  repeatedly 
received  assistance  from  the  munificence  of  former  legislatures, 
and  was  at  that  time  before  the  assembly  for  help ;  and  yet  its 
doors  were  closed  against  the  poor,  and  more  than  an  equivalent 
for  board  and  lodging  exacted;  that,  moreover,  the  almshouse, 
containing  over  one  thousand  inmates,  presented  an  extensive 
field  for  communicating  medical  instruction  to  students  attracted 


MEDICAL  HISTORY  OF  THE  PHILADELPHIA  ALMSHOUSE.  23 

from  all  parts  of  the  country  by  the  celebrity  of  the  school.  This 
petition  anticipating  extensive  preparation  for  clinical  accommo- 
dations, was  regarded  by  the  general  board  as  an  unwarrantable 
assumption  of  power  on  the  part  of  the  managers,  and  produced 
a  very  tart  correspondence,  which  I  have  no  doubt  produced  the 
passage  of  the  supplement  to  the  poor  law  of  1808. 

Until  October  25th,  1805,  no  fee  was  demanded  for  those  at- 
tending the  instructions  of  the  institution,  but  at  the  above  date 
a  ticket  was  directed  to  be  issued,  signed  by  the  president  and 
secretary  of  the  board  of  guardians,  at  the  price  of  eight  dollars — 
two  tickets  purchasing  a  perpetual  privilege.  The  office  of  pupils 
of  the  medical  officers  were  free  to  attend  without  charge.  In 
November,  1807,  Dr.  James  was  allowed  by  resolution  to  deliver 
lectures  in  the  green  room,  and  there  he  and  others  continued  to 
instruct  until  1811,when  the  surgeons  connected  with  the  almshouse 
asked  for  more  suitable  apartments,  in  which  operations  could  be 
performed,  and  thus  remove  from  the  ward  a  source  of  mischief 
to  the  other  sick.  To  correct  this  evil  the  board  had  the  build- 
ing called  the  d}^e  and  wash-house,  carried  up  an  additional 
story,  fitting  it  up  as  a  lecture  room,  with  two  adjoining  wards, 
capable  of  holding  each  twenty  or  thirty  patients,  and  here  were 
next  delivered  the  clinical  lectures. 

During  1813,  the  managers,  anxious  to  advance  the  reputation 
and  popularity  of  the  house,  were  induced  to  tender  to  any  stu- 
dent taking  their  ticket,  the  privilege  of  attending  a  case  of  labor; 
and  to  give  the  proposal  greater  publicity  it  was  by  their  author- 
ity announced  in  the  public  papers.  This  scheme  of  indiscrimin- 
ate admission  to  the  ward  in  the  lying-in  department  brought 
out  a  minority  of  protest,  which  was  not  only  a  sensible  paper 
on  the  subject  of  difference,  but  introduced  and  exposed  the 
suicidal  measures  of  the  board  on  another  matter  closely 
allied  with  the  success  of  the  almshouse  as  a  medical  school,  by 
making  the  simple  circumstance  of  holding  an  appointment  in 
the  Pennsylvania  Hospital  a  disqualification  for  holding  a  sim- 
ilar one  in  the  institution  over  which  the  managers  presided. 
They  urged  the  wisdom  of  selecting  the  very  best  talent  wherever 
found,  and  especially  the  propriety  of  seeking  as  many  from  the 
medical  school  as  possible.  That  the  force  of  this  may  be  under- 
stood it  must  be  remembered,  that  every  student  was  required  as  a 
condition  of  graduation,  to  take  a  ticket  in  the  Pennsylvania  Hos- 


24  MEDICAL  HISTORY  OP  THE  PHILADELPHIA  ALMSHOUSE. 

pital.  If,  therefore,  they  could  identify  the  interests  of  the  fac- 
ulty of  the  University  with  the  almshouse,  it  would  in  all  proba- 
bility procure  such  a  modification  of  the  rule  as  would  at  least 
leave  it  to  the  pleasure  of  the  student  whether  this  ticket  was 
taken  at  one  or  the  other.  This  protest  effected  a  change  of  sen- 
timent in  the  board,  securing  not  only  a  more  circumspect  modi- 
fication of  the  obstetrical  privilege,  but  a  repeal  of  the  law  so  far 
as  it  effected  the  eligibility  of  professional  men  serving  in  a  kin- 
dred institution,  and  on  the  6th  of  November,  1815,  produced  the 
very  result  contemplated. 

A  more  noble  spirit  on  the  part  of  the  managers  this  year,  also 
led  to  a  pleasant  interchange  of  civilities  between  the  sister  hos- 
pitals. The  steward  was  authorized  to  address  a  note  to  the 
residents  of  Pennsylvania  Hospital,  inviting  them  to  an  operation 
to  be  performed  at  the  almshouse;  and  this  privilege  was  after- 
wards made  perpetual. 

On  the  5th  of  January,  1818,  a  conference  was  held  between  a 
committee  of  the  trustees  of  the  University  and  the  board  of 
guardians,  with  a  view  of  establishing  more  extended  clinical 
teaching  in  the  almshouse.  The  number  of  students  had  been 
gradually  increasing.  In  1818,  there  were  fifty-three  in  attend- 
ance ;  but  the  succeeding  three  years  being  remarkable  for  the 
prevalence  in  the  house  of  malignant  disease,  had  no  doubt  some 
influence  in  diminishing  the  class,  for  in  1819  it  does  not  appear 
there  were  more  than  forty-three,  and  in  1820  but  twenty-two  in 
attendance.  In  1822,  however,  the  number  ran  up  to  one  hun- 
dred and  ten.  This  was  the  year  in  which  Dr.  Barton,  having 
been  allowed  to  convert  the  area  in  the  rear  of  the  centre  build- 
ing into  a  botanic  garden,  was  in  the  habit  of  taking  the  class 
among  the  plants  to  illustrate  the  subjects  of  his  lectures;  and 
the  year  also  in  which  Gibson,  Barton,  Horner,  Mitchell,  Lawrence 
and  Chapman,  all  accomplished  gentlemen,  were  wont  to  pour 
forth  the  treasures  of  their  experience  and  observation.  The  sub- 
ject of  a  botanic  garden  on  a  large  and  liberal  scale,  and  to  be 
placed  under  a  scientific  head,  had  been  a  favorite  idea  with  mem- 
bers of  both  the  medical  and  managers'  board,  but  could  not 
be  successfully  accomplished.  After  Dr.  Barton  left  the  board, 
the  old  garden  passed  into  the  hands  of  Dr.  Samuel  Jackson,  by 
whose  suggestion  a  greenhouse  was  constructed  for  the  more  com- 
plete protection  and  preservation  of  the  plants.     Between  the 


MEDICAL  HISTORY  OF  THE  PHILADELPHIA  ALMSHOUSE.  25 

years  1822  and  1828,  I  have  no  data  for  determining  the  num- 
ber of  students  attending  the  clinical  instruction. 

In  1827  it  was  announced  in  the  public  newspapers  that  the 
cases  of  recent  fractures  would  be  received  and  treated  in  the 
institution.  The  suggestion  came  from  the  surgical  staff,  and 
would  enable  them  to  furnish  illustrations  for  the  management 
of  a  very  important  class  of  accidents. 

During  1827,  Dr.  Thomas  Harris  asked  the  privilege  of  deliver- 
ing a  course  of  lectures  on  surgery  in  the  lecture-room  of  the 
house,  which  was  granted  by  the  guardians.  This  course  was 
didactic  in  its  character  and  had  no  connection  with  the  ordinary 
instruction  of  the  institution.  In  1828,  the  number  of  students 
was  seventy-five,  and  in  1830  rose  to  one  hundred  and  eighty- 
five.  August  11,  1834,  Dr. 'Burden,  then  a  member  of  the 
board  of  guardians,  offered  a  resolution  to  appoint  a  commit- 
tee to  confer  with  the  trustees  of  the  University  and  Jefferson 
Medical  College  on  subjects  connected  with  the  interests  of  the 
almshouse.  The  scheme  which  the  doctor  had  in  contemplation 
was,  in  the  first  place,  to  make  the  ticket  of  the  house  essential  to 
graduation,  and  in  the  second,  the  organization  of  a  summer  school 
of  practical  medicine  and  surgery  in  the  institution,  neither  of 
which  received  the  sanction  of  the  board.  The  first  was  asking 
a  discrimination  which  ought  not,  we  conceive,  ever  be  granted  to 
any  hospital ;  the  second  was  a  wise,  public-spirited,  practical 
suggestion,  which  ought  not  to  have  been  refused. 

It  was  this  year  that  the  faculty  of  Jefferson  Medical  College  then 
growing  into  deserved  importance,  requested  the  guardians  to  be 
placed  on  an  equal  status  with  the  University  in  regard  to  clinical 
teaching.  The  plan  they  proposed  was  to  set  apart  two  wards  for 
them  in  the  hospital — one  for  medical  and  one  for  surgical  cases — 
and  alternate  weeks  for  their  clinical  lectures.  Those  representing 
the  interests  of  the  University  objected  to  such  an  arrangement  as 
calculated  to  mar  the  harmony  of  both  the  schools  and  the  hos- 
pital. They  declared  that  they  had  undertaken  the  development 
of  a  clinical  school  at  a  time  when  scarcely  a  ticket  was  sold,  and 
that  they  had  at  length  succeeded  in  making  it  a  source  of  revenue 
to  the  board,  and  a  formidable  rival  of  the  Pennsylvania  Hospital, 
the  latter  not  selling  over  thirty  tickets ;  and  lastly,  that  their  con- 
nection with  the  clinic  in  no  way  prevented  the  students  of 
another  college  enjoying  equal  advantages  with  their  own. 


26  MEDICAL  HISTORY  OP  THE  PHILADELPHIA  ALMSHOUSE. 

This  year  (1834)  was  one  of  great  prosperity  to  the  Philadelphia 
Hospital.  Two  hundred  and  twenty  students  were  in  attendance  • 
the  proceeds  accruing  therefrom  amounting  to  fourteen  hundred 
and  twenty  dollars.  The  board  of  managers  appreciating  the 
courtesies  due  to  men  of  liberal  education  and  position  in  the 
profession,  with  commendable  propriety  tendered  gratuitous 
admission  to  all  medical  men  attached  to  the  army  and  navy. 
These  lectures  were  delivered  on  Wednesday  of  every  week  during 
the  winter  months.  In  1835,  at  the  request  of  Drs.  Patterson  and 
Colhoun,  the  day  was  changed  to  Saturday,  in  accommodation  to 
the  instruction  in  the  Jefferson  College,  which  this  year  sent 
seventy-nine  students  to  the  clinic.1 

The  transportation  was  no  inconsiderable  item.  Long  lines 
of  omnibuses  (for  there  were  then  no  street  cars)  were  stationed 
about  Ninth  and  Chestnut  Streets  on  Saturday  mornings,  and 
in  a  few  minutes  crowds  of  students  full  of  life  and  excitement 
were  stowed  away — not  seated — in  glorious,  good-natured  confu- 
sion; and  at  the  usual  salutation  of  the  knight  of  the  whip,  "  all 
right,"  were  whirled  away  at  a  spanking  speed,  some  to  the  South 
street  ferry,  to  be  carried  over  in  a  boat  which  has  long  been  sus- 
pected as -one  of  Charon's — and  is  so  far  as  the  transportation  of 
spirits  is  concerned,  not  untruly ;  others  by  the  Market  street 
bridge.  Some  of  my  very  pleasant  recollections  of  college  life  in 
1837,  are  associated  with  those  weekly  trips  so  admirably  calcu- 
lated to  relieve  the  tedium  of  town,  and  regale  the  lungs  with 
more  invigorating  air.  The  lecture  room  was  situated  in  what  is 
now  the  lunatic  department,  and  only  recently  abandoned.  It- 
was  the  most  capacious  and  finely  arranged  amphitheatre  in  the 
country,  and  capable  of  seating  from  seven  to  eight  hundred  per- 
sons. Until  1845,  this  hospital  continued  to  be  the  great  clinic 
school  of  the  country,  annually  oj)enmg  its  exhaustless  treasures 
of  disease  to  crowds  of  educated,  zealous  inquirers  after  medical 
knowledge.  The  unfortunate  events  which  in  1845  succeeded  the 
death  of  the  cockroach,  terminated  the  instructions  for  several 
years. 

f1  In  the  "Picture  of  Philadelphia,  etc.,  A  Complete  Guide  for  Strangers,"  published  by 
E.  L.  Carey  &  A.  Hart  in  1835,  the  following  occurs  :  "At  the  almshouse  there  is  an  infirmary, 
and  clinical  lectures  are  delivered  to  the  medical  class  during  the  winter  by  the  professors  of 
the  medical  school.  There  are  two  graduates  and  four  medical  students,  who  reside  in  the 
house ;  and  four  surgeons,  four  physicians,  and  two  accouchers  attached  to  the  institution. 
Resident  students  pay  an  initiation  fee  of  two  hundred  dollars,  and  are  boarded  and  lodged  in 
the  house  for  one  year.  Medical  students  pay  ten  dollars  a  ticket  to  attend  the  practice  of  the 
infirmary  and  have  the  use  of  the  library  containing  nearly  3,000  volumes."] 


MEDICAL  HISTORY  OF  THE  PHILADELPHIA  ALMSHOUSE.  27 

CERTIFICATES  AND  TICKETS. 

In  1817  a  diploma  or  certificate  was  ordered  to  be  engraved,  the 
impressions  from  which  were  made,  some  on  paper  and  some  on 
parchment,  designed  for  the  resident  pupils,  and  which  were  fur- 
nished at  three  and  four  dollars  a  copy.  In  September,  1832,  a 
new  plate  was  produced,  altogether  more  artistically  executed,  and 
in  1835,  a  small  vignette  view  of  the  house  was  ordered  to  be 
engraved  and  printed  on  the  tickets.  In  1860,  another  litho- 
graphic engraving  of  a  certificate  was  executed.  The  design 
represents  a  front  view  of  the  institution,  and  was  signed  by  the 
president  of  the  board  of  guardians,  the  president  of  the  medical 
board,  and  the  secretary. 

After  a  pause  of  several  years,  the  profession  becoming  more 
and  more  sensible  of  the  great  injustice  and  tyranny  perpetrated 
against  the  reputation  of  a  city  enjoying  such  unexampled  pros- 
perity as  a  centre  of  medical  education,  by  excluding  them  from  an 
institution  supported  largely  from  their  own  pockets,  and  possessed 
of  the  most  ample  resources  as  a  clinical  school,  began  to  move  in 
the  matter. 

On  the  1st  of  May,  1854,  the  Philadelphia  county  medical  society 
addressed  a  communication  to  the  board  of  guardians,  asking  that 
the  almshouse  doors  be  opened  to  students  of  medicine.  The 
document  was  forcibly  written,  but  produced  no  change  in  the 
views  of  that  body.  In  August  of  this  year,  Dr.  John  Reese, 
register  of  the  medical  faculty  of  the  Pennsylvania  College,  in 
behalf  of  that  institution,  communicated  with  the  board  on  the 
same  subject,  and  guaranteed,  if  its  wards  were  opened  to  public 
instruction,  the  sale  of  fifty  tickets  from  that  school  alone.  These 
appeals,  no  doubt,  had  some  weight  with  the  guardians,  but  to 
Drs.  Henry  H.  Smith  and  J.  L.  Ludlow  (and  I  speak  from  per- 
sonal knowledge)  more  than  to  all  others  combined,  is  the  pro- 
fession in  Philadelphia  and  the  country  at  large  indebted  for  the 
re-establishment  of  a  clinical  school  within  the  walls  of  this 
institution.  Neither  must  Dr.  Penrose  be  overlooked  in  this  im- 
portant work,  as  he  labored  indefatigably  for  the  same  end.  I 
make  no  mention  of  my  own  efforts  in  the  same  direction,  for 
while  I  did  what  I  could,  I  was  comparatively  a  stranger  in  the  city 
and  had  no  influence  whatever.  These  gentlemen  visited  each 
member  of  the  board  of  guardians  personally,  and  by  an  un- 
wearied, persevering  presentation  of  the  subject  in  every  possible 


28  MEDICAL  HISTORY  OF  THE  PHILADELPHIA  ALMSHOUSE. 

shape,  finally  succeeded  by  their  importunity,  as  the  widow  with 
the  unjust  judge,  in  revolutionizing  the  settled  sentiment  of  the 
board,  securing  a  favorable  report  from  the  hospital  committee, 
and  its  adoption  on  the  motion  of  Dr.  Henley,  by  the  general 
board  of  guardians.  The  rules  for  the  government  of  the  clinic 
were  reported  on  the  6th  of  September,  1854,  and  provided  for  the 
election  of  two  physicians  and  two  surgeons  in  addition  to  the 
chief  resident  officers. 


THE  ADMINISTRATION  BY  A  RESIDENT-IN-CHIEF,  AND  A  BOARD  OF 
LECTURERS  ON  CLINICAL  MEDICINE  AND  SURGERY. 

On  the  same  day  on  which  the  rules  were  reported  (6th  Sep- 
tember, 1854),  the  guardians  proceeded  to  elect  the  medical  officers, 
when  Drs.  J.  L.  Ludlow  and  Robert  Coleman  were  selected  phy- 
sicians and  Drs.  Henry  H.  Smith  and  D.  H.  Agnew  surgeons. 
Dr.  Coleman  being  compelled  by  previous  engagements  to  resign, 
Dr.  Caspar  Morris  was  elected  in  his  place,  and  on  the  30th  of  the 
following  October,  the  staff  was  increased  by  the  appointment  of 
Dr.  R.  A.  F.  Penrose,  obstetrician,  to  the  institution.  Tickets  of 
admission  were  fixed  at  ten  dollars,  including  transportation  two 
days  in  the  week,  Wednesday  and  Saturday,  for  four  months. 
The  West  Chester  railroad  which  passes  through  the  grounds  of 
the  institution,  was  just  being  completed,  and  an  arrangement  was 
made  with  the  superintendent  to  run  cars  from  Broad  and  Market 
streets  to  some  point  opposite  the  building  on  the  days  of  the 
clinical  lectures.  The  second  week  in  October,  1854,  an  immense 
train  left  Broad  street,  filled  to  repletion  with  medical  students, 
to  witness  the  inauguration  of  this  important  event.  This  pas- 
senger train,  I  believe,  was  the  first  which  passed  over  the  long 
stretch  of  trestle-work  supporting  the  road  across  the  meadows  of 
this  property.  Its  living  freight  was  landed  opposite  the  river 
point.  Certainly  not  less  than  seven  hundred  persons  were  present 
in  the  old  amphitheatre,  and  the  first  clinic  of  the  new  era  was 
held  after  some  appropriate  remarks  by  Drs.  Smith  and  Ludlow. 
On  the  following  June  of  1855,  the  hospital  committee  deemed  it 
proper  to  increase  the  number  of  medical  officers,  and  by  their 
recommendation  two  additional  were  added  to  each  staff.  These 
were  Drs.  Joseph  Carson  and  J.  B.  Biddle  to  the  medical ;  Drs. 
John  Neill  and  R.  P.  Thomas  to  the  surgical ;   and  Drs.  Wilson 


MEDICAL  HISTORY  OF  THE  PHILADELPHIA  ALMSHOUSE.  29 

Jewell  and  Caspar  Morris  to  the  obstetrical  departments,  the  latter 
gentleman  being  transferred  from  the  medical  to  the  obstetrical 
at  his  own  request.1 

On  the  2d  of  July,  1855,  the  period  for  the  annual  election  of  a 
chief  medical  officer,  Dr.  Robert  K.  Smith  was  selected  by  the 
guardians,  and  co-operated  most  efficiently  with  the  clinical  board, 
delivering  in  October  a  most  excellent  introductory,  and  partici- 
pating in  the  clinical  instructions  communicated  to  the  class.  On 
the  21st  of  July,  1856,  Dr.  A.  B.  Campbell  was  elected  chief  resi- 
dent physician.  A  remarkable  change  this  year  came  over  the 
board  of  guardians  in  reference  to  the  house  instruction.  It  is 
altogether  foreign  to  my  purpose  to  enter  into  any  analysis  of  the 
instrumentalities  employed  to  sway  the  opinions  of  these  gentle- 
men, although  they  were  quite  patent,  I  presume,  to  any  member 
of  the  medical  organization  connected  with  the  institution.  It  is 
sufficient  to  say,  that  on  the  motion  of  a  member,  offered  on  the 
22d  of  December,  1856,  clinical  instruction  in  the  Philadelphia 
Hospital  was  abolished  after  the  termination  of  the  lectures  then 
in  progress.  The  reason  adduced  in  justification  of  this  act,  was 
the  failure  of  the  clinic  to  meet  its  own  expenses.  The  record 
stultified  the  allegation  ;  and  those  who  were  cognizant  of  the  fact 
could  not  but  feel  indignant  at  so  audacious  a  falsification  of  the 
case.  There  were  at  that  very  time  seventy-five  students  in 
attendance,  a  larger  number  than  usually  attended  the  hospitals 
either  in  this  country  or  Europe. 

On  the  8th  of  June,  1857,  Dr.  Campbell  resigned,  and  was  suc- 
ceeded by  Dr.  James  McClintock,  very  shortly  after  which  event 
the  visiting  members  of  the  medical  organization  all  resigned, 
several  of  the  resident  physicians  withdrew  from  the  house,  and 
again  the  institution  ceased  to  administer  to  the  wants  of  the 
medical  class  of  Philadelphia. 

On  the  5th  of  July,  1858,  Dr.  Robert  K.  Smith  again  became 
chief  resident  officer,  and  on  the  19th  of  the  same  month,  under 
the  auspices  of  this  new  medical  head,  Mr.  Reall,  a  member  of  the 
board  of  guardians,  proposed  to  re-establish  a  board  of  clinical 
lecturers.  The  subject  for  a  time  was  laid  over,  until  the  11th  of 
October,  when  the  students  of  the  different  medical  colleges  of  the 

P  In  the  copy  of  Dr.  Agnew's  lecture  from  which  this  is  reprinted,  the  following  is  written 
in  lead  pencil :  "  This  is  an  error  certainly,  at  least,  I  have  no  recollection  of  such  a  request," 
Signed  "  Caspar  Morris,  June,  1875."] 


30  MEDICAL  HISTORY  OF  THE  PHILADELPHIA  ALMSHOUSE. 

city  addressed  a  communication  to  the  guardians,  praying  for  the 
revival  of  medical  instruction. 

On  the  22d  of  November  they  acceded  to  the  request,  and  pro- 
ceeded at  once  to  ballot  for  gentlemen  to  discharge  this  duty. 
Drs.  Joseph  Carson,  J.  B.  Biddle,  J.  Aitken  Meigs  and  Samuel 
Dickson  were  elected  lecturers  on  clinical  medicine ;  Drs.  John 
Neill,  W.  S.  Halsey,  Richard  J.  Levis  and  D.  H.  Agnew  on  clinical 
surgery ;  and  Drs.  R.  A.  F.  Penrose  and  E.  McClellan  on  obstet- 
rics and  diseases  of  women  and  children.  Dr.  Dickson's  health 
not  allowing  him  any  increase  in  his  labors,  was  compelled  to 
decline  serving,  and  in  his  place  Dr.  J.  M.  DaCosta  was  elected 
one  of  the  physicians;  and  under  this  organization  the  hospital 
commenced  again  to  discharge  one  of  its  legitimate  functions  to 
the  community. 

On  the  4th  of  July,  1859,  the  old  board  of  guardians,  which 
for  many  years  had  been  selected  by  popular  vote,  was  abolished, 
and  a  new  one,  consisting  of  twelve  members,  appointed  by 
the  courts  and  Councils  came  into  power.  This  organization,  con- 
sisting of  the  most  respectable  and  intelligent  gentlemen  in  our 
community,  men  of  enlarged  liberal  views,  conjoined  with  superior 
practicable  ability,  after  a  careful  survey  of  the  field,  entered  on 
the  work  of  reform.  Among  the  subjects  which  earliest  occupied 
their  attention  was  the  medical  department  of  this  institution. 
The  result  of  these  investigations  was  a  return  to  the  old  system, 
dispensing  with  the  office  of  chief  resident,  and  placing  the  hos- 
pital in  charge  of  a  medical  board,  consisting  of  twelve  members, 
to  act  as  physicians,  surgeons  and  obstetricians,  and  who  were  to 
visit  the  institution  four  times  a  week.  The  election  for  these 
officers  took  place  on  the  8th  of  August,  1859,  at  which  Drs.  J.  L. 
Ludlow,  William  F.  Maybury,  Charles  P.  Tutt  and  Robert  Lucket 
were  selected  to  constitute  a  medical  staff;  Drs.  S.  D.  Gross, 
Richard  J.  Levis,  Robert  Kenderdine  and  D.  H.  Agnew,  a  surgical 
staff;  and  Drs.  R.  A.  F.  Penrose,  John  Wiltbank,  William  D. 
Stroud  and  Lewis  Harlow,  an  obstetrical  staff.  It  was  in  August  of 
this  year  that  the  professors  of  the  Homeopathic  College  proposed 
in  a  communication  addressed  to  the  guardians,  to  take  the  entire 
charge  of  the  medical  department,  and  furnish  all  the  medicines 
for  the  sick  without  any  charge  whatever. 

On  the  27th  of  December,  1859,  the  medical  board  underwent 
some  changes,  in  consequence  of  questions   connected  with  the 


MEDICAL  HISTORY  OF  THE  PHILADELPHIA  ALMSHOUSE.  31 

political  state  of  the  country,  and  which  have  since  inaugurated 
a  revolution  of  unparalleled  magnitude,  the  issues  of  which,  on 
the  destinies  of  race,  nation,  and  the  world,  no  human  mind  can 
foresee.  Dr.  Lucket,  espousing  the  southern  view  of  the  question, 
induced  a  large  number  of  medical  students  to  abandon  the 
medical  colleges  of  Philadelphia  and  enter  the  institutions  of 
their  own  states.  The  doctor  becoming  the  medical  Moses  of  this 
exodus  left  his  place  in  the  board,  to  which  Dr.  J.  M.  DaCosta 
was  elected  in  December,  1859.  In  the  same  month  Dr.  Wilt- 
bank  resigned,  and  to  supply  the  vacancy  Dr.  George  Ziegler 
was  elected.  Again  on  May  7, 1861,  Dr.  Maybury  was  compelled 
by  the  extent  of  his  professional  duties  to  withdraw  from  the 
board,  to  which  place  Dr.  0.  A.  Judson  was  elected. 

Since  the  new  organization  of  the  board  of  guardians,  by  which 
in  a  great  measure  this  house  has  been  rescued  from  the  vortex 
of  politics,  its  medical  prosperity  and  popularity  have  been  stead- 
ily increasing,  until  it  may  now  be  pronounced  the  great  clinical 
school  of  the  country.  The  change  was  not  accomplished  with- 
out a  struggle.  There  is  a  class  of  persons  who  can  only  exist  in 
the  seething  caldron  of  political  agitation,  and  who  cling  to  offi- 
cial places  like  the  barnacles  to  a  ship's  bottom.  Of  such  tfyere 
were  some  who  lost  no  opportunity  to  prefer  charges  of  misman- 
agement, in  order  to  shake  the  confidence  of  the  public  in  the 
administration  of  the  present  organization. 

On  the  25th  of  June,  1860,  it  was  stated  in  Common  Council 
that  a  great  increase  had  taken  place  in  the  mortality  of  the  insti- 
tution since  the  change  in  the  medical  system,  and  a  committee 
was  appointed  to  investigate  the  facts  of  the  case.1  In  the  report 
of  these  gentlemen  it  will  be  seen  that  instead  of  the  mortality 
being  increased  it  had  been  greatly  diminished.  They  took  the 
last  year  of  the  old  board  of  guardians,  which  expired  on  July  1, 

1859,  and  contrasted  it  with  the  first  year  of  the  present  board, 
which  terminated  on  July  1,  1860.  By  examination  it  appeared 
the  year  ending  July,  1859,  the  average  population  of  the  house 
was  2,513,  and  the  deaths  for  the  same  period  were  657,  or  26.15 
per  cent,  of  the  average  population.     For  the  year  ending  July, 

1860,  the  average  population  was  2,520,  and  the  deaths  for  the 
same  time  were  589,  or  23.30  per  cent,  of  the  average  population. 

1  Journal  of  Common  Council,  from  May  to  November,  1866,  page  121, 


32  MEDICAL  HISTORY  OP  THE  PHILADELPHIA  ALMSHOUSE. 

This  showed  a  decrease  of  68  in  the  number  of  deaths,  or  11  per 
cent,  on  the  mortality  of  the  previous  year. 

In  the  insane  department,  in  1859,  with  an  average  popu- 
lation of  400,  there  were  96  deaths,  or  24  per  cent,  on  the 
above  average.  In  1860,  the  average  population  was  425,  and 
72  deaths,  or  not  quite  17  per  cent,  of  the  average  population; 
a  decrease  of  38  per  cent,  in  the  mortality  of  the  previous 
year.  They  go  on  further  to  state  that  it  must  be  remembered 
that  only  a  part  of  the  population  of  the  almshouse  is  under 
medical  treatment,  and  that  the  proper  basis  to  determine  the 
mortality  among  the  inmates  should  be  taken  from  the  hospital. 
For  this  purpose  the  committee  took  the  last  published  report  of 
the  late  chief  resident  of  the  former  board  for  1858.  Its  author 
declares  during  that  period  the  institution  shows  a  smaller  mortal- 
ity than  had  been  known  for  many  years.  By  that  report,  in  the 
various  wards  of  the  hospital,  children's  asylum,  and  nursery, 
there  were  treated  5,335  cases  of  disease,  of  which  number  548 
died,  or  10.29  per  cent.  The  books  of  the  present  board  showed 
6,176  cases  treated,  and  478  deaths,  or  7.74  per  cent.,  exhibiting  a 
decrease  of  25  per  cent,  on  the  mortality  of  the  former  year. 
Thjis,  then,  was  a  vindication  of  the  wisdom  of  the  guardians  in 
establishing  the  present  medical  organization,  and  rested  on  a 
mathematical  demonstration,  which  even  its  enemies  dared  not 
gainsay. 

On  the  1 0th  of  September,  1860,  the  medical  board  addressed 
the  guardians  on  the  propriety  of  throwing  open  the  wards  of 
the  hospital  for  free  clinical  instruction.  This  proposition  was 
considered  from  a  liberal  and  intelligent  standpoint,  in  its  broader 
and  more  general  bearings,  and  on  the  24th  of  September,  I860, 
received  their  cordial  sanction ;  and  its  doors  have  been  opened 
to  this  time,  and  it  is  to  be  hoped  through  all  time  to  come,  its 
doors  may  never  be  closed  against  or  a  fee  craved  from  those  who 
enter  its  halls  in  search  of  that  knowledge,  which  can  alone  render 
them  qualified  to  discharge  the  functions  of  a  divine  art. 

In  the  month  of  April,  1861,  the  guardians  furnished  another 
proof  of  the  confidence  which  they  reposed  in  the  medical  board 
by  authorizing  the  construction  of  the  present  lecture  room, 
which  for  elegance  and  convenience  has  no  superior ;  and  which 
was  formally  inaugurated  on  the  16th  of  October,  1861,  in  an 
able  address  by  Dr.  J.  L.  Ludlow,  on  "  The  Rise  and  Progress  of 
Clinical  Instruction." 


MEDICAL  HISTORY  OF  THE  PHILADELPHIA  ALMSHOUSE.  33 

MUSEUM. 

On  the  25th  of  November,  1814,  the  first  efforts  were  made  to 
establish  a  hospital  museum.  The  board  required  every  resident 
pupil  to  leave  in  the  house  a  preparation  made  by  himself.  That 
the  rule  was  enforced  for  a  time  there  can  be  no  doubt,  for  on  the 
26th  of  February,  1822, 1  find  the  acknowledgment  of  the  follow- 
ing anatomical  preparations :  A  corroded  kidney,  by  J.  T.  Sharp- 
less;  a  side  view  of  the  head,  with  the  vessels  injected,  by  J.  M. 
Fox ;  a  specimen  showing  the  anatomy  of  scrotal  hernia,  by 
Edward  L.  DuBarry  ;  and  a  foetal  preparation  showing  the  vessels 
peculiar  to  circulation.     Where  are  these  now  ? 

The  23d  of  November,  1840,  Dr.  Burden,  one  of  the  guardians, 
presented  a  resolution  to  fit  up  a  room  in  the  centre  building  of 
the  hospital  for  a  museum,  which  was  to  be  placed  under  the 
charge  of  the  apothecary,  to  whom  all  the  morbid  specimens  were 
to  be  given  for  preservation.  The  first  museum  contemplated 
was  evidently  to  be  only  a  depository  for  normal  anatomical 
specimens ;  this  last  may  be  considered  as  the  inception  of  a 
pathological  cabinet.  There  were  three  things  which,  of  course, 
rendered  it  impracticable.  First,  the  curator  was  to  be  the 
apothecary,  who  knew  nothing  of  pathology ;  second,  there  were 
no  provisions  made  for  dissecting  the  specimens ;  and  last,  at  this 
very  period  the  subject  of  post-mortems  was  embarrassed  by 
more  formalism  than  would  be  necessary  to  ratify  and  induct  an 
archbishop  into  his  holy  calling. 

On  the  10th  of  September,  1860,  the  present  board  of  guardians, 
acting  on  the  recommendation  of  the  medical  board,  authorized 
the  founding  of  a  pathological  museum,  to  which  the  writer  was 
assigned  as  curator.  For  the  perpetuation  of  this  important 
undertaking  an  annual  appropriation  of  two  hundred  dollars  is 
made,  which,  if  judiciously  expended,  will  serve  to  preserve  a 
large  amount  of  pathological  material.  The  work  has  begun  ; 
already  a  considerable  collection  has  been  placed  on  the  shelves 
of  this  museum,  some  of  them  quite  unique  of  their  kind,  and 
all  most  valuable  illustrations  of  morbid  structure.  Although 
much  of  this  work  has  been  done  at  considerable  personal  incon- 
venience, yet  I  assure  you  that  it  is  with  no  ordinary  feelings  of 
personal  pride  and  pleasure  that  I  regard  the  association  of  my 
name  with  an  enterprise  which,  if  prosecuted  with  ordinary 
3 


34  MEDICAL  HISTORY  OF  THE  PHILADELPHIA  ALMSHOUSE. 

industry  and  intelligence,  will  in  a  few  years  secure  to  the  Phila- 
delphia Hospital  the  most  valuable  collection  of  morbid  anatomy 
to  be  found  anywhere  in  the  country. 


LIBRARY. 


Among  the  wants  specified  by  the  board  in  1805,  when  they 
went  before  the  legislature  for  aid,  was  a  room  to  be  appropri- 
ated for  a  library.  About  the  beginning  of  the  year  1808  this 
work  commenced,  and  on  the  9th  of  May  one  hundred  and  fifty 
dollars  were  appropriated  by  the  managers  for  the  purchase  of 
books,  to  be  selected  by  the  physicians  of  the  institution.  Rules 
were  reported  shortly  after  for  its  management,  and  the  senior 
resident  student  appointed  librarian,  at  which  time  the  books 
were  labelled  and  numbered.  In  1810  another  appropriation  of 
one  hundred  and  fifty  dollars  was  made  for  the  same  purpose. 
On  the  28th  of  December,  1812,  a  committee  was  appointed  to 
draft  rules  for  the  management  of  the  library,  and  at  this  date 
there  was  an  unexpended  balance  to  its  credit  of  four  hundred 
dollars,  which  was  money  received  from  the  house  pupils. 

In  1813,  a  rule  was  passed  conferring  a  life  privilege  of  the  use  of 
the  library  for  the  sum  of  thirty  dollars.  This  year  three  hundred 
dollars  were  expended  on  books,  duplicates  of  all  the  elementary 
works  being  ordered.  In  1815  free  access  was  allowed  to  phy- 
sicians and  students  who  should  attend  the  practice  of  the  house 
for  two  years,  and  also  to  private  pupils  of  the  medical  officers  of 
the  institution.  In  1816  the  apothecary  was  appointed  librarian 
and  the  library  catalogued. 

On  the  18th  of  August,  1818,  by  a  report  of  Dr.  McClellan,  the 
library  contained  1,022  volumes,  and  597  different  works.  On 
the  8th  of  November,  1824,  the  managers  passed  a  resolution 
making  an  annual  appropriation  of  two  hundred,  dollars  for  the 
benefit  of  the  library.  In  1827  Dr.  Horner  presented  the  insti- 
tution with  one  hundred  and  twenty  theses  from  Edinburg.  In 
1831,  it  was  again  catalogued  by  Dr.  Rivanus,  one  of  the  resident 
physicians,  and  contained  some  very  valuable  works. 

In  November,  1836,  Dr.  Charles  Pickering  applied  to  the  board 
for  certain  works  in  their  possession  for  the  use  of  the  United 
States  exploring  expedition,  which  were  not  attainable  in  this 
country,  offering  a  large  advance  on  the  importation  price  as  an 


MEDICAL  HISTORY  OF  THE  PHILADELPHIA  ALMSHOUSE.  35 

inducement  to  sell.  The  matter  was  referred  to  the  medical 
board  and  refused.  Accessions  were  made  from  time  to  time,  by 
appropriations  made  out  of  the  proceeds  resulting  from  the  sale 
of  clinical  tickets,  until  it  numbered  over  3,000  volumes,  the 
finest  collection  of  ancient  medicine  and  surgery  probably  any- 
where to  be  found. 

For  the  last  fourteen  years  very  little  attention  has  been 
bestowed  on  this  important  appendage  to  a  great  hospital.  On 
the  contrary,  it  has  been  plundered  by  the  vandalism,  to  which 
it  has  been  exposed,  of  much  valuable  matter.  At  present,  how- 
ever, it  has  been  placed  under  the  care  of  Dr.  Tutt,  and  having 
been  removed  from  the  lunatic  department  is  being  rearranged 
in  an  excellent  room  appropriated  to  its  use,  in  the  north  end 
of  the  hospital  building.  An  appropriation  is  now  annually 
made  by  the  present  board  of  guardians  for  its  improvement  and 
preservation,  and  we  may  hope  to  see  it  again  growing  in  value 
every  year. 


INSANE  DEPARTMENT. 

The  almshouse  buildings,  as  first  constructed,  were  not  adapted 
to  the  reception  of  insane  patients,  especially  if  laboring  under  a 
violent  type  of  mental  disease.  The  managers,  therefore,  were  in 
the  habit  of  placing  such  cases  in  the  Pennsylvania  Hospital, 
whose  arrangements  were  safer  and  better  for  the  care  of  lunatics. 
The  expense  of  supporting  them  in  this  institution  was  an  item 
of  much  complaint  on  the  part  of  the  managers  of  the  almshouse, 
and  on  July  4, 1803,  the  physicians  had  a  meeting  on  this  subject. 
They  recommended  in  order  to  accommodate  the  insane  poor,  to 
convert  as  much  of  the  new  range  of  buildings  (at  Eleventh  and 
Spruce  streets)  as  could  be  spared  into  cells  for  their  accommoda- 
tion. The  board  not  thinking  this  locality  altogether  safe,  fitted 
up  the  cellar  under  the  west  wing  of  the  house,  then  occupied  as 
a  dining-room.  This  improvement  was  completed  in  December, 
1803,  and  thither  to  this  subterranean  prison  were  ten  persons 
removed  from  the  Pennsylvania  Hospital — the  number  of  the 
violent  class  then  under  the  care  of  the  managers.  The  names  of 
these  first  ten  occupants  were  John  Savage,  Robert  Crawford 
George  W.  Odenheimer,  John  McClean,  Stephen  West,  Mary 
McFall,  Catharine  Erringer,  Christiana  Griskey,  Sarah  Tomb  and 
Abbe  Conly. 


36  MEDICAL  HISTORY  OP  THE  PHILADELPHIA  ALMSHOUSE. 

The  portion  thus  set  apart  in  a  few  years  became  insufficient, 
some  of  the  cells  containing  two  maniacs.  The  medical  officers 
again  pressed  the  necessity  of  additional  buildings,  as  a  measure 
enforced  by  every  consideration  of  humanity.  These  underground 
cells  were  clamp,  chilly  caverns,  with  insufficient  light  and  im- 
perfect ventilation ;  they  were  close  to  the  sick  and  surgical  wards, 
and  the  noise  of  these  creatures  bereft  of. reason,  howling  like 
caged  beasts,  exerted  not  only  an  unpleasant  influence  on  the  sick, 
but  even  shocked  the  public  ear.  In  1833,  the  insane  were 
removed  in  common  with  the  other  poor,  to  the  present  building, 
a  part  of  which  had  been  constructed  for  this  unfortunate  class, 
that  is  furnished  with  those  mechanical  contrivances  which  were 
deemed  essential  to  their  treatment. 

Among  the  results  of  scientific  medicine,  there  are  none  gentle- 
men, which  have  been  fraught  with  so  much  blessing  as  those 
which  have  crowned  the  rational  study  of  mental  disease.  The 
damp  and  gloomy  cells  of  the  old  almshouse  on  Spruce  street, 
and  the  walls  and  subterranean  vaults  of  the  present,  furnished 
familiar  demonstrations  of  the  frightful  armamentarium  at  their 
command,  not  indeed  for  restoring  reason,  but  to  scare  her  forever 
from  her  seat  in  the  soul.  You  have  but  to  cross  the  area  of  this 
enclosed  scjuare,  to  see  still  the  iron  hooks  in  the  floor  where  they 
were  tied  down  hands  and  feet,  the  rings  in  the  outer  wall  where 
they  were  chained  like  wild  animals,  when  led  from  their  gloomy 
abode  to  enjoy  for  a  little  while  the  pure  air  and  sunshine  of 
heaven.  There  too,  may  be  still  seen  the  traces  of  blood,  the 
marks  of  the  teeth,  as  they  have  in  their  agony  vainly  endeavored 
to  gnaw  through  the  doors  which  restrained  their  liberty,  and  not 
the  least  horrible  of  these  inquisitorial  mechanisms,  there  still 
stands  the  composing  chair  in  which  the  doomed  lunatic  was 
secured,  his  head  supporting  a  capacious  box  of  ice,  which  melt- 
ing, poured  its  chilling  contents  adown  his  person  for  hours 
together. 

In  1835,  the  hospital  committee  authorized  the  purchase  of 
books,  prints  and  musical  instruments  for  the  use  of  the  lunatic 
department,  and  more  than  usual  interest  for  a  time  was  mani- 
fested in  improving  its  condition.  In  the  beginning  of  1845  a 
ball  was  given  for  their  amusement,  and  with  such  satisfactory 
results,  that  Dr.  Dunglison  in  the  following  April  asked  its 
repetition. 


MEDICAL  HISTORY  OP  THE  PHILADELPHIA  ALMSHOUSE.  37 

On  the  17th  of  September,  1849,  Dr.  Henley  was  appointed 
assistant  physician  to  this  department  and  to  the  smallpox  hospital 
at  a  salary  of  five  hundred  dollars.  In  this  position  he  continued 
until  February,  1852,  when  he  resigned,  and  was  succeeded  by  Dr. 
J.  H.  Benton.  Shortly  after,  however,  Dr.  Benton  was  superseded 
by  the  re-appointment  of  Dr.  Henley  to  his  old  post,  with  a  salary 
increased  to  seven  hundred  dollars.  This  office  was  abolished,  I 
think  in  1854,  and  from  that  time  forward  the  asylum  until  a 
recent  period,  was  lapsing  rapidly  into  disorder  and  decay.  Among 
the  noblest  acts  of  the  present  board  of  guardians,  was  the  reorgan- 
ization of  this  department.  None  but  those  who  were  conversant 
with  the  house,  can  form  any  conception  of  its  utter  inefficiency 
to  fulfill  the  purposes  contemplated  by  such  an  institution.  It 
was  visited  for  the  most  part  by  sightseers,  attracted  by  the  same 
motives  as  one  visits  an  exhibition  of  animals.  The  hallucina- 
tions and  eccentricities  of  these  poor  God  smitten  creatures  were 
the  subject  of  thoughtless  sport,  and  became  strengthened  and 
confirmed  by  being  maintained  in  a  state  of  constant  activity.  It 
was  a  burning  shame  on  the  good  name  of  this  Christian  com- 
munity, that  such  a  cage  of  idleness,  uncleanness  and  disorder 
should  have  been  tolerated  for  a  moment  in  their  midst. 

On  the  24th  of  September,  1859,  the  insane  were  separated  from 
the  hospital  department  and  placed  under  the  charge  of  a  medical 
officer,  Dr.  S.  W.  Butler,  at  a  salary  of  one  thousand  dollars  a 
year.  Since  this  event  a  new  state  of  things  has  been  introduced. 
An  air  of  order,  comfort  and  cheerfulness  is  noticable  on  every 
side ;  industry  has  taken  the  place  of  idleness ;  and  there  may  be 
seen  numbers  of  the  inmates  busily  engaged,  some  cultivating 
with  judgment  and  evident  gratification  a  garden  of  vegetables ; 
some  sewing  and  making  up  garments  of  various  kinds;  some 
working  at  shoes,  and  some  enlivening  the  ear  with  the  delightful 
sounds  of  music,  executed  with  no  ordinary  taste  and  skill.  By 
the  last  year's  report  it  will  be  seen  that  nearly  all  the  vegetables 
used  by  the  house  have  been  cultivated  by  the  insane,  amounting 
in  money  value  to  nine  hundred  and  fifty-eight  dollars  and  sixty- 
three  cents.  They  will  soon,  it  is  further  stated,  make  all  the 
clothing  and  shoes  consumed  by  the  department.  Another 
ameliorating  and  salutary  feature  is  the  revival  by  Dr.  Butler  of 
the  musical  entertainments,  when  the  inmates  at  the  sound  of  the 
violin  and  piano,  select  their  partners,  and  with  all  the  decorum 


38  MEDICAL  HISTORY  OP  THE  PHILADELPHIA  ALMSHOUSE. 

and  conventional  proprieties  of  rational  society,  tread  the  giddy 
mazes  of  the  dance,  exhibiting  the  most  striking  expressions  of 
mirth  and  enjoyment.  Such  a  regimen  is  well  calculated  to  intro- 
duce new  trains  of  thought,  which  serve  either  to  substitute  those 
which  constitute  the  phenomena  of  their  insanity,  or  enable  the 
individuals  to  correct,  by  a  legitimate  induction,  the  delusions 
under  which  they  may  labor. 

I  am  indebted  to  Dr.  Butler  for  the  tables  which  furnish  the 
following  results.  From  1834  to  1861  (inclusive)  there  have  been 
received  into  the  men's  department,  3,858  insane  persons,  whose 
social  state  was  as  follows:  1,803  single,  1,054  married,  332 
widowed,  and  669  unknown.  Of  the  habits  of  the  number,  the 
following  may  be  stated :  449  were  temperate,  371  moderate, 
528  intemperate,  leaving  2,510  unknown.  In  the  women's  depart- 
ment, from  1835  to  1861  (inclusive)  there  have  been  received  3,473, 
the  social  and  habits  of  whom,  however,  were  not  compiled  later 
than  1845,  and  are  as  follows :  329  single,  299  married,  and  222 
unknown ;  214  temperate,  14  moderate,  67  intemperate,  and  635 
unknown,  in  a  total  of  928. 


APOTHECARIES  AND  HOUSE  PUPILS. 

Until  June  6,  1788,  there  is  no  evidence  that  the  medicines 
requisite  for  the  sick  were  prepared  in  the  house,  or  that  persons 
instructed  in  medicine  resided  in  the  institution.  The  apothecary 
shop  was  established  at  the  date  stated,  and  John  Trust,  being 
recommended  by  the  physicians,  was  appointed  to  that  office.  The 
duties  were  both  pharmaceutical  and  medical,  and  this  officer  was 
required  either  to  be  a  graduate  or  an  advanced  student.  Under 
the  first  he  was  to  prepare  and  dispense  the  prescriptions  of  the 
attending  physicians;  and  under  the  second,  he  was  to  attend  to 
the  ward  dressings,  keep  a  record  of  the  name,  date  of  admission, 
sex,  age,  disease,  event  of  each  inmate,  and  preserve  an  account 
of  the  women  delivered  in  the  obstetrical  ward.  The  remunera- 
tion was  board,  washing  and  lodging.  In  1789,  an  additional  one 
was  deemed  necessary,  and  we  find  the  name  of  John  Davidson 
mentioned  as  apothecary  and  house  pupil.  In  1802  the  number 
was  increased  to  three,  and  the  s}^stem  of  juniors  and  seniors  first 
introduced. 

The  eldest  was  styled  the  senior  student,  the  next  the  junior 
student,  and  the  third   called  the  apothecary  to  the  infirmary. 


MEDICAL  HISTORY  OF  THE  PHILADELPHIA  ALMSHOUSE.  39 

The  senior  was  to  attend  the  sick,  keep  a  history  of  all  the  cases 
which  the  medical  student  might  direct,  with  a  register  of  the 
name,  date  of  admission,  age,  sex,  disease  and  event.  The  junior 
was  to  dress,  cup,  bleed  in  the  surgical  wards,  visit  the  working 
wards  daily,  and  if  any  were  sick  report  the  same  to  the  senior, 
and  keep  in  order  the  surgical  instruments  and  apparatus  of  the 
house.  The  apothecary,  besides  preparing  the  prescriptions,  was 
required  to  cup  and  bleed  in  the  medical  ward.  Each  of  these 
house  pupils  was  to  pay  eighty  dollars  and  serve,  the  senior  two 
and  a  half,  and  the  others  three  and  a  half  years. 

In  1811,  the  number  of  house  pupils,  or  apprentices  as  they 
were  occasionally  termed,  was  increased  to  four  during  the  winter 
and  three  in  the  summer  season,  each  to  pay  one  hundred  dollars 
into  the  treasury  for  the  benefit  of  the  house.  In  1813  the  num- 
ber was  fixed  at  four  for  the  entire  year ;  two  seniors  and  two 
juniors.  All  candidates  to  be  eligible  for  election  must  have  been 
under  the  instruction  of  some  practitioner  for  two  years,  must  have 
attended  one  course  of  medical  lectures,  and  were  required  to  pay 
before  entering  on'service  one  hundred  dollars  into  the  hands  of  the 
treasurer,  and  to  give  bonded  security  for  the  faithful  performance 
of  his  duties.  The  seniors  rotated  monthly  in  the  different  depart- 
ments of  the  hospital,  the  juniors  every  two  months.  The  obstet- 
rical cases  were  attended  alternately  by  both  juniors  and  seniors. 
The  juniors  prepared  all  prescriptions,  kept  a  careful  record  of 
the  same,  and  were  present  with  the  seniors  in  their  stated 
rounds  with  the  sick. 

In  1816,  the  house  pupils'  fee  was  increased  to  one  hundred  and 
fifty  dollars,  and  the  term  of  service  reduced,  to  twelve  and  six 
months.  This  year,  at  the  suggestion  of  the  visiting  physicians, 
the  managers  believing  there  were  ample  duties  to  employ  one 
person  constantly  in  the  apothecary's  shop,  disconnected  the  office 
of  apothecary  to  the  infirmary  from  that  of  house  pupil  and 
established  it  as  a  distinct  position,  with  a  salary  of  three  hundred 
dollars  a  year.  After  a  single  year's  trial  the  office  was  abolished, 
but  so  injudiciously  that  on  the  2d  of  February,  1818,  they  were 
compelled  to  re-establish  if- again.  Gerald  S.  Marks  was  appointed 
to  this  office  and  continued  to  occupy  it  until  his  death  in  1832. 
He  was  succeeded  by  his  son,  Samuel  P.  Marks,  and  next  by 
James  N.  Marks,  first  as  an  assistant  and  afterwards  as  principal, 
which  position  he  continued  to  fill  with  unexampled  ability  until 
March  8,  1852 — seventeen  years.     Mr.  James  N.  Marks  was  for 


40  MEDICAL  HISTORY  OP  THE  PHILADELPHIA  ALMSHOUSE. 

many  years  a  member  of  the  board  of  guardians,  a  man  of 
practical  ability,  whose  record  I  have  no  doubt  stands  unim- 
peached.  After  the  resignation  of  Mr.  Marks  the  board  elected 
Mr.  Huffnell  apothecary,  in  which  capacity  he  continued  to  act 
until  1856,  when  Mr.  Bender,  who  had  been  acting  as  assistant, 
became  principal. 

In  1817,  the  population  of  the  hospital  had  so  increased  that 
it  was  found  necessary  to  provide  a  larger  number  of  resident 
pupils,  and  to  meet  the  wants  thus  arising  eight  were  elected,  to 
serve  six  and  twelve  months.  In  1820,  the  title  by  which  these 
gentlemen  were  called  was  changed  from  house  pupil  to  that  of 
house  surgeons  and  house  physicians.  The  following  year,  1821, 
the  resident  fee  was  increased  to  two  hundred  dollars.  In  Novem- 
ber, 1822,  the  managers  believing  that  fewer  residents  could  meet 
all  the  demands  of  the  institution  reduced  the  number  to  six, 
and  the  next  year,  1823,  in  consequence  of  a  civil  strife  between 
some  of  the  managers  and  the  house  physicians,  the  medical 
board  advised  a  change  in  the  mode  of  attending  the  sick,  by 
dispensing  altogether  with  resident  under-graduates,  and  electing 
two  graduates  in  medicine  of  known  ability,  who  were  to 
receive,  instead  of  a  salary,  an  honorarium  in  the  form  of  a  piece 
of  plate,  with  a  proper  inscription,  not  to  exceed  one  hundred 
dollars  in  value.  The  plan  proposed  was  adopted  without  the 
contemplated  plate,  but  could  not  have  met  the  expectations  of 
the  board,  as  the  resolution  was  rescinded  the  same  year  and 
resort  had  to  the  old  plan. 

On  the  8th  of  November,  1824,  the  medical  board  recommended 
the  examination  of  all  candidates  for  the  medical  service  of  the 
hospital,  that  they  might  be  able  to  secure  the  best  qualified 
talent,  and  this  received  the  sanction  of  the  managers.  Another 
suggestion  of  the  medical  board,  which  was  endorsed  by  the  same 
gentlemen,  was  the  election  of  two  additional  pupils  to  be  called 
recorders,  whose  duty  it  was  to  keep  an  accurate  history  of  all 
cases  of  disease  in  the  institution,  a  work  which,  had  it  been 
carried  out  in  good  faith  to  this  day,  would  have  constituted  a 
treasury  of  medical  knowledge  unequalled  in  value  in  any 
country.  Nothing  practical  or  important,  however,  emanated 
from  this  office.  Here  and  there  among  musty,  defaced  papers, 
I  discovered  a  few  histories,  as  one  searching  among  ancient 
ruins  meets  with  broken  pillars  and  fragments  of  dismembered 


MEDICAL  HISTORY  OP  THE  PHILADELPHIA  ALMSHOUSE.  41 

arches.     They  never  can  be  gathered  together  from  amidst  the 
dust  of  time  and  decay  and  framed  into  symmetrical  pieces. 

In  1828,  the  seniors,  by  a  resolution  of  the  board  of  guardiaus, 
were  styled  resident  physicians,  and  the  juniors  resident  students. 
In  1835  the  fee  exacted  from  those  elected  to  either  position  was 
two  hundred  and  fifty  dollars,  which  seems  to  have  so  remained 
until  September,  1839,  when  it  was  reduced  to  fifty  dollars  and 
the  price  of  board.  From  that  period  to  the  present,  the  number 
of  resident  physicians  has  been  eight,  boarded  and  lodged  at  the 
expense  of  the  institution,  and  required  to  deposit  one  hundred 
dollars  as  a  collateral  assurance  for  the  fulfillment  of  their  con- 
tract, to  be  returned  at  the  expiration  of  their  term  of  service  or 
when  honorably  discharged.  There  have  been  since  1788,  the 
year  in  which  it  may  be  said  the  system  of  residentship  was 
established,  three  hundred  and  fifty  pupils,  or  physicians  officiating 
in  this  capacity,  among  whom  the  names  will  be  found  of  the 
most  distinguished  physicians  and  surgeons,  dead  and  living,  from 
the  north  and  south,  for  the  last  quarter  of  a  century.  Here  is 
one  of  those  examples  of  moral  reaction  or  compensation,  as 
noticeable  among  the  groups  incident  to  the  social  state,  as  between 
the  kingdoms  of  nature  elsewhere.  Poverty,  misfortune  and  sick- 
ness, universally  regarded  as  evils,  yet  counterbalanced  by  yield- 
ing, as  fields  for  scientific  observation,  a  rich  harvest  of  solid, 
practical  medical  knowledge. 


EPIDEMICS. 

In  an  institution  giving  shelter  to  the  destitute,  decrepid  and 
broken-down,  the  existence  of  epidemic  and  malignant  disease 
may  very  naturally  be  anticipated,  and  this  house  has  proved  no 
exception  to  the  rule.  In  the  early  period  of  its  existence,  very 
little  satisfactory  information  can  be  gathered  in  regard  to  the 
details  of  its  prevailing  maladies.  During  the  spring  months  of 
1776,  the  inmates  suffered  very  severely  both  from  smallpox  and 
putrid  sore  throat.  Many  cases  of  the  worst  character  were  taken 
from  the  house  and  quartered  in  private  lodgings,  with  the  hope 
of  staying  their  fatal  progress.  No  mention  is  made  either  of  the 
number  of  cases  or  the  deaths,  and  therefore  the  extent  of  the 
mortality  can  only  be  approximately  arrived  at.  The  cost  of 
burials,  with  a  population  of  two  hundred,  and  in  the  ordinary  • 


42  MEDICAL  HISTORY  OP  THE  PHILADELPHIA  ALMSHOUSE. 

health  of  the  institution,  was  about  eighteen  pounds.  The  year 
under  consideration,  1776,  the  expense  of  burying  amounted  to 
forty-seven  pounds,  sufficient  to  show  that  the  mortality  had 
been  doubled. 

In  1779,  a  form  of  intermittent  fever  prevailed  during  the  month 
of  April,  concerning  which  it  is  said,  "  there  were  deaths  daily, 
and  much  distress  in  the  house."  For  nine  years  following  1779, 
the  institution  appears  to  have  enjo}^ed  a  wonderful  exemption 
from  fatal  diseases,  or  until  1788,  when  a  person  in  the  month  of 
February  was  admitted  from  Southwark,  indisposed  from  some 
undeveloped  affection.  Shortly  after,  his  disease  proved  to  be 
smallpox  which  spread  with  great  rapidity  among  the  inmates. 
This  was  among  the  most  terrible  scourges,  as  vaccination  had  not 
been  discovered,  and  against  inoculation  there  was  a  wide-spread 
prejudice. 

In  1793,  Philadelphia  was  visited  by  yellow  fever,  and  this 
institution  was  doomed  to  pass  through  the  severest  ordeal  which 
it  had  ever  sustained.  It  is  quite  impossible  for  us  at  this  day  to 
form  any  just  conception  of  the  j)anic  which  seized  the  public 
mind  at  the  appearance  of  this  desolating  plague.  There  is  some- 
thing very  appalling  in  the  moral  effect  of  those  unseen  agencies 
with  which  God  sometimes  scourges  a  city  or  a  nation.  Men  can 
preserve  their  composure  on  the  field  of  battle,  where  the  mail- 
clad  hosts  of  contending  armies,  struggle  for  victory  amid  the  roar 
of  artillery  and  the  shouts  of  their  captains;  but  let  the  angel  of 
pestilence,  that  walketh  in  darkness  or  wasteth  at  the  noonday, 
shake  from  his  sable  wings  the  invisible  spores  of  infection  and 
death,  the  merchant  sinks  at  his  desk,  the  artisan  totters  and  falls 
at  his  bench,  an  acquaintance  making  a  transient  call  suddenly 
grows  pale  and  feeble,  is  borne  home  to  his  bed  to  struggle  a  little, 
gasp  and  die.  I  say,  let  men  witness  a  few  such  scenes  as  these, 
and  they  soon  betray  the  veriest  cowardice  and  fear. 

During  the  prevalence  of  the  fever  the  whole  face  of  the  city 
was  changed.  There  were  then  no  funeral  trains  attended  with 
the  usual  pomp  and  pageantry  of  mourning;  no  coffins  of  elabor- 
ate workmanship  to  contain  the  mortal  remains  of  the  dead  and 
borne  with  formal  steps  to  their  last  resting  place.  On  every 
hand  the  beholder  encountered  open  and  unattended  carts  con- 
taining rude  boxes,  exposed  to  the  public  gaze  and  hurried  with 
all  despatch  to  be  buried  out  of  sight — not  in  single  graves,  but 


MEDICAL  HISTORY  Of'tHE  PHILADELPHIA  ALMSHOUSE.  43 

numbers  together  in  capacious  pits.  Men  cared  not  to  tarry  on 
the  street  but  hastened  on  with  furtive  glance,  as  though  the  fell 
destroyer  followed  on  their  track.  There  were  no  hearty,  joyous 
salutations.  Men  exchanged  the  common  civilties  of  recognition 
as  though  they  never  expected  to  meet  again.  The  ties  even  of  kin- 
dred blood  lost  their  wonted  power ;  families  became  a  terror  to 
one  another,  fleeing  asunder  as  one  would  hurry  from  devouring 
flame.  The  song  of  the  drunkard  had  ceased ;  the  saloons  of 
dissipation  were  closed ;  the  haunts  of  vice  were  unfrequented  ; 
and  even  the  shameless  votaries  of  lust  and  lewdness  slunk  into 
their  dens  of  infamy.  As  a  means  of  protecting  the  inmates,  the 
medical  attendants  recommended  the  board  to  grant  no  admis- 
sions whatever.  Still  the  precaution  proved  unavailing ;  the 
disease  broke  out  in  the  house  and  large  numbers  were  attacked ; 
very  many  were  removed  to  the  hospital  on  Bush  Hill.  There 
are  no  records  or  sources  of  information  from  which  any  statis- 
tical light  can  be  drawn,  either  to  determine  number  of  cases  or 
the  mortality.  That  it  was  great  there  is  little  room  for  doubt. 
When  the  disease  was  at  its  height  most  of  the  managers  infected 
by  the  common  panic  and  widespread  distress  did  not  venture  to 
attend  the  institution.  But  there  were  the  medical  attendants  and 
the  steward  who  never  deserted  their  posts,  but  stood  by  this 
flock  of  decrepid,  friendless  poor,  with  a  devotion  and  moral 
heroism,  which  I  rejoice  to  say  has  ever  been  the  glory  of  our 
profession. 

During  the  prevalence  of  the  epidemic  the  demand  for  graves 
was  so  great  that  the  poor  were  unable  to  dig  them  with  proper 
care.  Potter's  Field,  now  the  beautiful  Washington  Square,  was 
the  public  burying  ground.  The  interments  were  so  numerous 
and  incomplete  as  to  call  forth  a  remonstrance  against  depositing 
any  more  bodies  within  the  enclosure. 

In  1801,  there  was  a  pauper,  Thomas  Wilkinson,  in  the  house, 
who  during  the  epidemic  assisted  in  placing  in  coffins  and  bury- 
ing 1 ,500  victims  of  yellow  fever ;  and  in  consideration  of  his 
having  accomplished  so  unparalleled  an  office  of  danger  and 
humanity,  he  was  pensioned  with  a  little  extra  food  and  clothing. 
Here  was  a  man  possessed  of  a  wonderful  degree  of  fortitude.  I 
should  have  given  much  to  know  such  a  one :  for  depend  upon 
it,  had  such  a  nature  been  properly  understood,  it  could  have 
been  taken  by  the  hand  and  conducted  into  some  nobler  sphere 


44  MEDICAL  HISTORY  OF  THE  PHILADELPHIA  ALMSHOUSE. 

of  activity  and  duty  than  is  usually  found  within  the  walls  of  a 
public  charity.  On  the  30th  of  December,  the  disease  having 
disappeared,  the  doors  of  the  house  were  again  thrown  open  to 
persons  entitled  to  its  aid. 

The  managers  after  witnessing  the  horrors  of  the  late  epidemic, 
had  become  exceedingly  sensitive  on  the  subject  of  what  they  con- 
sidered contageous  diseases  ;  and  in  1795,  when  the  city  board 
sent  to  the  institution  cases  of  dysentery,  which  was  then  prevail- 
ing both  in  the  wards  of  the  hospital  and  throughout  the  town, 
they  remonstrated  strongly  against  their  actions. 

In  August,  1798,  Drs.  Pleasants  and  Boyce  communicated  to 
the  managers  the  unpleasant  intelligence  of  the  re-appearance  of 
yellow  fever  in  the  city,  and  asked  the  adoption  of  additional  pre- 
cautionary measures  to  avoid  the  introduction  of  any  affected 
person.  The  steward  was  accordingly  directed  to  allow  no  admis- 
sions whatever  without  a  certificate  from  one  of  the  attending 
physicians.  The  subject  of  ventilation  began  at  this  time  to 
receive  some  attention.  The  windows  were  so  altered  as  to  lower 
from  above — and  I  may  add  here,  in  passing,  that  this  subject  has 
not  yet  been  exhausted  even  in  the  present  palatial  building. 
Frequent  conferences  took  place  at  this  time  between  the  man- 
agers and  the  board  of  health,  and  between  the  former  and  the 
managers  of  the  marine  city  hospital,  with  a  view  to  provide 
accommodations  and  sustenance  for  the  poor  of  the  city  and  dis- 
tricts, and  to  aid  such  persons  who  desired  to  remove  from  the 
city  limits.  It  was  certainly  a  period  of  the  most  deplorable  suf- 
fering among  the  poor.  On  the  10th  of  September,  1798,  they 
concluded  to  solicit  a  loan  on  subscription,  to  be  reimbursed  out 
of  any  fund  designated  by  the  legislature.  During  the  month  of 
November,  between  two  and  three  hundred  children,  utterly 
destitute,  were  sent  to  the  managers,  their  parents  having  fallen 
victims  to  the  fever.  Some  idea  may  be  formed  of  the  state  of  the 
public  mind  when  it  is  stated,  that  during  the  fever  of  1793, 
17,000  persons  fled  from  the  city ;  and  during  that  of  1798, 
50,000,  leaving  only  something  over  3,000  persons  in  Philadel- 
phia; and  that  from  August  8th  to  October  3d  of  these  two 
visitations,  4,625  individuals  fell  victims  to  the  disease.1 

This  year  the  whooping  cough  prevailed  to  an  unparalleled  de- 
gree ;  it  visited  almost  every  house,  and  in  order  to  isolate  the 

1  Hazzard's  Register,  Penn.,  Vol.  10,  p.  112. 


MEDICAL  HISTORY  OF  THE  PHILADELPHIA  ALMSHOUSE.  45 

children,  Luke  Morris,  one  of  the  managers,  took  a  house  some 
distance  from  the  institution. 

In  July,  1802,  great  apprehension  was  again  entertained  of 
another  visitation  of  fever.  The  doors  were  closed  against  the 
admission  of  any  paupers ;  no  stranger  was  allowed  to  visit  the 
house ;  the  use  of  the  hearse  was  not  permitted  for  any  burial 
but  such  as  took  place  from  the  institution;  nor  were  the  resident 
pupils  allowed  to  visit  anyone  in  the  city.  This  interdict  was 
maintained  until  the  9th  of  November,  and  whatever  influence  it 
may  have  exerted,  certainly  the  house  enjoyed  a  comparative 
immunity  from  disease.  Again  in  September,  1803,  another  alarm 
prevailed  in  consequence  of  the  re-appearance  of  fever  in  the  city ; 
and  again  were  admissions  refused  except  to  the  officers  of  the 
house.  The  board,  with  the  consent  of  the  governor  of  the  state, 
took  the  Pennsylvania  arsenal  as  a  temporary  accommodation 
for  the  poor.  They  afterwards  procured  a  house  on  the  banks  of 
the  Schuylkill,  at  Race  street,  belonging  to  Dr.  Curry,  which  was 
supplied  with  twenty-five  bedsteads  and  bedding,  a  horse-cart  and 
other  necessary  appliances.  This  proved  to  be  the  last  visit  which 
the  almshouse  received  from  the  yellow  fever. 

During  the  month  of  August,  1 807,  an  epidemic  of  influenza  broke 
out  in  the  institution,  attacking  both  inmates  and  officers,  and 
prevailing  in  so  violent  a  form  and  so  genera],  as  to  interrupt  the 
ordinary  routine  of  business. 

The  health  of  the  institution  appears  to  have  been  generally 
good  after  this  until  1811.  In  August  of  that  year  a  violent  type 
of  dysentery  made  its  appearance  in  the  wards,  and  proved  so 
extensive  and  malignant  that  the  board  had  many  of  the  worst 
cases  carried  out  of  the  house  and  quartered  in  a  barn,  which 
stood  on  a  vacant  piece  of  land  near  by,  called  the  pasture  lots, 
and  which  it  appears  was  followed  almost  immediately  after  by 
salutary  results. 

In  order  to  isolate  the  cases  of  smallpox  which  from  time  to  time 
made  their  appearance,  a  house  was  taken  in  1815,  directly  opposite 
the  institution  on  Spruce  street,  into  which  such  patients  were 
placed. 

The  fall  of  1817,  was  one  of  much  sickness,  distress  and  mortal- 
ity in  the  almshouse.  The  ordinary  diseases  of  the  house  all  tended 
to  assume  an  adynamic  type  throughout  the  winter,  and  after  the 
commencement  of  the  new  year  1818,  in  January,  typhus  fever 


46  MEDICAL  HISTORY  OP  THE  PHILADELPHIA  ALMSHOUSE. 

prevailed  to  such  a  degree  as  to  invite  inquiry  into  the  sanitary 
state  of  the  wards  from  the  board  of  health.  The  disease  com- 
menced about  November  1,  1817,  and  as  near  as  I  can  ascer- 
tain, up  to  January  5,  1818 — two  months — there  had  been 
eighty-six  cases;  sixteen  had  died,  twenty  were  discharged,  fifty 
remained,  and  twenty-five  of  these  were  considered  to  be  convales- 
cing. What  number  of  this  remaining  fifty  died  it  is  impossible 
to  learn.  This  statement  was  made  by  Dr.  James,  after  which 
there  is  a  record  of  nine  cases  of  which  six  died.  By  February, 
the  number  and  malignancy  of  the  cases  increased  to  such  an 
extent  that  the  managers  requested  the  general  board  to  issue  no 
more  admissions,  and  accordingly  on  the  28th,  the  latter  concluded 
to  send  all  cases  of  undeveloped  disease  to  the  quarantine  house, 
until  their  character  was  declared ;  should  they  prove  to  be  typhus, 
they  were  sent  to  the  sugar-house,  an  old  building  which  stood  on 
the  almshouse  grounds  contiguous  to  the  institution.  It  was 
about  this  time  the  general  board  framed  an  address  to  the  medi- 
cal officers,  asking  their  opinion  on  the  contagiousness  of  the  fever 
then  prevailing.  Their  answer  was  like  some  oracular  response, 
characterized  by  a  degree  of  caution  and  non-committal  which 
would  have  done  credit  to  the  most  adroit  politician  of  1862;  yet  it 
might  be  gathered  from  the  counsel  which  they  gave,  urging  "the 
separation  of  the  affected  from  the  others,"  that  they  all  believed 
what  they  did  not  care  to  express.  Among  their  recommendations 
was  the  increase  in  both  quality  and  quantity  of  the  diet  of  the 
poor,  as  calculated  to  enable  these  helpless  beings  to  resist  the 
morbid  influences.  The  managers  thought  it  better,  however,  to 
refuse  this,  and  to  regale  them  by  highly  nutritious  and  stimu- 
lating beverages  of  molasses,  ginger  and  water. 

In  1823,  cases  of  smallpox  becoming  numerous,  it  was  thought 
best  to  take  the  hospital  at  Bush  Hill,  the  superintendence  of 
which  was  committed  to  Dr.  John  K.  Mitchell  on  the  2d  of  Decem- 
ber of  that  year,  who  continued  to  discharge  his  duties  with 
devotion,  alike  creditable  to  his  goodness  of  heart  and  his  well- 
known  professional  ability,  until  February  2d,  1824,  as  long  as 
the  necessity  for  his  services  existed,  at  which  time  he  received 
the  complimentary  thanks  of  the  board,  and  was  voted  a  piece  of 
plate,  which  his  son,  Dr.  S.  Weir  Mitchell,  has  informed  me  was  a 
pitcher  bearing  an  appropriate  inscription. 


MEDICAL  HISTORY  OF  THE  PHILADELPHIA  ALMSHOUSE.  47 

I  find  also  a  report  containing  the  results  of  his  service,  from 
which  it  appears  that  there  were  one  hundred  and  fifty-eight 
persons  received  into  the  hospital.  Of  this  number  one  hundred 
and  fifteen  cases  were  unprotected,  and  seventy  of  these  died ; 
twenty-five  had  been  vaccinated,  all  of  which  recovered  ;  five  had 
been  inoculated,  of  which  two  died ;  and  of  the  remaining  nine* 
nothing  of  their  previous  history  was  known.  Eighty-four  of  the 
cases  occurred  in  males,  of  whom  forty-seven  died  ;  seventy-four 
in  females,  of  whom  thirty  died.  The  greatest  mortality  was 
among  the  males,  and  curious  as  it  may  seem,  the  fatality  among 
those  previously  inoculated,  or  who  had  had  variola,  was  greater 
than  among  those  vaccinated.  On  June  21,  1824,  the  thanks  of 
the  guardians  were  tendered  to  Dr.  John  Bell,  who  was  associated 
with  Dr.  Mitchell,  for  his  humane  and  faithful  attention  to  such 
as  labored  under  this  loathsome  disease.  Dr.  Bell's  name  con- 
tinued to  be  associated  with  the  smallpox  hospital  until  very  lately 
when  it  was  closed. 

In  1827,  Dr.  Thomas  Brinckle  had  the  care  of  this  hospital ;  a 
report  was  made  in  September  of  that  year,  from  which  it  would 
appear  there  were  received  one  hundred  and  seventy-six  patients, 
sixty-one  of  whom  died  and  one  hundred  and  fifteen  recovered. 
In  eighteen  of  these  cases  the  patients  had  passed  through  a  pre- 
vious attack,  three  of  whom  died  ;  fifty-three  cases  had  been  vac- 
cinated, and  eight  died  ;  a  result  corroborating  the  report  of  Dr. 
Mitchell,  and  tending  to  establish  what  I  believe  is  at. present 
asserted,  that  vaccination  is  a  better  protective  than  either  inocu- 
lation or  variola  itself.  As  early  as  1818,  the  subject  of  erecting  a 
building  for  contagious  diseases,  or  pesthouse,  as  it  was  termed, 
had  been  agitated  by  the  board,  and  while  it  was  the  conviction  of 
a  majority  of  the  members,  that  the  matter  of  providing  for  con- 
tagious diseases  did  not  legitimately  belong  to  the  guardians,  yet  as 
a  necesshvy,  the  construction  of  such  a  building  was  recommended. 
On  the  5th  of  June,  1835,  a  resolution  to  the  same  effect  was  passed, 
but  never  carried  into  effect,  while  the  almshouse  stood  on  the  east 
side  of  the  Schuylkill,  the  old  sugar-house  being  used  for  that 
purpose.  In  1841,  however,  after  consultation  with  the  medical 
board,  a  site  was  selected  on  the  west  side  of  this  institution,  on 
which  a  building  was  erected  and  called  the  outer  hospital,  for 
cases  of  an  infectious  nature.  This  was  afterwards  occupied 
as  the  residence  of  the  physician-in-chief,  having  been  moved  in 


48  MEDICAL  HISTORY  OF  THE  PHILADELPHIA  ALMSHOUSE. 

its  totality  to  its  present  situation  on  the  Darby  road,  at  the  very 
trifling  cost  of  about  two  thousand  one  hundred  dollars,  and  is  now 
occupied  by  Dr.  Butler,  the  physician  in  charge  of  the  lunatic 
department.  To  provide  for  cases  of  smallpox,  the  guardians  have 
been  in  the  habit  of  using  the  old  mansion-house  between  the 
institution  and  the  gate  of  entrance  from  Darby  road.  The  lia- 
bility of  the  board  of  health  to  take  charge  of  cases  of  smallpox, 
has  been,  and  I  believe  still  continues  to  be,  a  point  on  which  a 
wide  difference  of  views  exist.  In  1850,  the  solicitor  of  the  board 
of  guardians  was  requested  to  frame  a  petition  to  the  legislature, 
praying  their  body  might  be  relieved  of  this  duty  ;  still  in  1852 
ah  act  was  passed  giving  to  the  board  the  right  to  charge  three 
dollars  a  week  for  every  case  of  contagious  disease  for  which  their 
body  provided.  The  hospital  on  Islington  lane  having  been  closed 
on  the  1st  of  April,  1860,  strange  as  it  may  appear,  in  a  commu- 
nity proverbial  for  its  wise  and  liberal  provisions  for  almost  every 
species  of  physical,  moral  and  mental  destitution  and  suffering, 
Philadelphia  is  to-day  without  a  public  place  where  either  citizen 
or  alien  could  command  the  services  of  a  physician  or  nurse  if 
overtaken  by  contagious  disease. 

In  1832,  Philadelphia  was  visited  by  the  cholera,  which  pro- 
duced an  alarm  only  equaled  by  that  of  the  yellow  fever  in  1793 
and  1798.  In  July  the  medical  staff  advised  the  non-reception 
of  cases,  and  an  immediate  provision  for  such  as  occurred  within 
their  jurisdiction  outside  of  the  house.  The  physicians  to  the 
out-door  poor  held  a  meeting,  at  which  Dr.  Condie  presided,  and 
recommended  the  establishment  of  temporary  hospitals  to  be 
placed  under  their  care,  and  to  receive  all  such  cases  as  were  not 
thought  proper  subjects  for  admission  to  the  house.  At  that  time 
the  present  almshouse  was  in  process  6f  erection,  the  present 
lunatic  department  being  almost  completed.  About  the  21st  of 
July  a  case  appeared  in  the  infirmary  of  the  institution,  then  in 
charge  of  Dr.  Hodge,  and  it  was  at  once  resolved  to  remove  all 
the  healthy  paupers  over  the  river  to  the  west  building,  designed 
then  for  a  hospital,  and  these  were  the  first  occupants  of  the  new 
institution.  The  guardians  next  made  application  to  commodore 
Baron  for  the  privilege  of  removing  others  still  remaining  to  the 
naval  asylum,  but  this  was  declined,  as  the  commodore  did  not 
feel  authorized  to  allow  its  occupation  by  civil  authorities  other 
than  as  a  hospital.      A  subsequent  resolution  empowered  the 


MEDICAL  HISTORY  OF  THE  PHILADELPHIA  ALMSHOUSE.  49 

president  of  the  board  of  guardians,  Mr.  Lippincott,  with  the 
mayor  of  the  city,  to  arrange  for  the  admission  of  a  number  of 
cholera  patients  into  the  asylum. 

In  the  house  the  cases  increased  daily,  until  a  general  panic 
took  place.  Nurses  became  clamorous  for  an  increase  in  wages, 
which  was  granted.  These,  between  terror  and  a  want  of  moral 
sense,  were  seized  with  a  kind  of  mad  infatuation.  They  drank 
the  stimulants  provided  for  the  sick,  and  in  one  ward,  where  the 
pestilence  raged  in  its  most  fearful  forms,  and  where  between  the 
dead  and  the  dying  the  sight  was  most  appalling,  these  furies 
were  seen  lying  drunk  upon  or  fighting  over  the  dead  victims  of 
the  disease. 

Persons  rescued  from  shipwreck  have  furnished  histories  of 
some  very  singular  mental  phenomena,  the  product  of  utter, 
hopeless  despair,  disarranging  the  complex  machinery  of  the 
intellectual  and  emotional  organization,  so  that  while  the  great 
hulk  freighted  with  living  souls  was  settling  down  into  its  grave 
of  waters,  some  would  laugh  as  though  in  the.  ecstacy  of  joy,  and 
others  command  in  vehement  tones  of  authority  the  billows  to 
roll  back  and  the  tempest  to  hush.  We  call  all  such  extravagant 
exhibitions  hysterical,  but  the  mental  and  physical  reactions  are 
none  the  less  curious  to  either  the  metaphysician  or  the  psychol- 
ogist. 

In  this  state  of  disorder,  application  was  made  to  Bishop 
Kendrick  for  sisters  of  charity.  The  request  was  granted,  and 
these  devoted  ministers  of  mercy,  at  once  entered  on  their  mission 
of  danger,  restoring  '  order  and  diffusing  hope  by  the  calm  and 
self-possessed  manner  with  which  they  moved  among  the  dis- 
eased. These  sisters  remained  at  their  post  until  the  20th  of 
May,  1833. 

During  the  epidemic  the  utmost  attention  was  given  to  the 
study  and  treatment  of  the  disease.  Dr.  Hodge  has  informed  me 
that  at  the  suggestion  of  Dr.  Horner  the  saline  solution  was 
thrown  into  the  veins,  in  order  to  provide  for  the  blood  lesion 
which  was  alleged  by  several  prominent  authorities  to  exist,  but 
in  no  case  were  any  good  results  obtained.  Large  double  tin 
cases  were  likewise  constructed,  in  which  the  patients  were  placed, 
while  external  warmth  was  communicated  by  filling  the  interval 
between  the  case  and  its  metallic  lining  with  hot  water.  Little, 
if  any,  benefit  was  experienced  from  this  mechanism. 
4 


50  MEDICAL  HISTORY  OF  THE  PHILADELPHIA  ALMSHOUSE. 

In  1849,  the  cholera  returned ;  and  in  July  a  meeting  was  called 
by  the  mayor  to  consult  on  the  best  measures  for  the  exigency 
again  likely  to  be  forced  on  the  community.  This  meeting  took 
place  at  the  office  in  the  city,  and  was  attended  by  Dr;>.  Benedict 
and  Page  from  the  institution  ;  and  Drs.  Harris,  Me:gs,  Pearce 
and  Dillingham  of  the  city.  The  board  of  guardians,  after 
receiving  all  the  light  possible  from  an  interchange  of  views, 
concluded  to  appoint  a  committee  to  carry  out  any  medical  sug- 
gestions made  by  the  medical  officers  of  the  house.  The  cases 
increased  rapidly  in  the  institution.  The  wash-house  which 
stands  in  the  centre  of  the  hollow  square  was  occupied  first  as  a 
cholera  hospital,  and  I  remember  well  passing  through  the  build- 
ing and  witnessing  with  sad  interest  the  poor  victims  in  every 
stage  of  the  disease.  It  was  an  excessively  hot  day,  yet  the}7 
were  all  as  cold  as  a  block  of  ice,  and  the  lines  of  death  were 
legibly  traced  on  every  face.  Dr.  Massenburg,  from  Hampton, 
Virginia,  was  appointed  temporary  resident  at  the  hospital  at 
this  time ;  a  most  amiable  and  intelligent  gentleman,  one  of  the 
first  medical  acquaintances  I  made  after  coming  to  the  city.  He 
was  attacked  with  the  disease  while  absent  a  few  hours  on  a  visit 
to  the  town  and  died  in  great  agony,  notwithstanding  that  the 
most  untiring  efforts  were  made  in  his  behalf. 

The  earliest  case  of  disease  in  the  house  was  on  the  27th  of 
June,  1849.  A  colored  man,  William  Jones,  was  brought  into 
the  black  medical  from  the  city  on  that  day  and  died  before 
night.  The  second  case  was  likewise  a  negro,  Isaac  Wood,  who 
was  brought  from  the  city  on  the  29th  and  died  the  same  day. 
Between  this  date  and  the  1st  of  July  nine  other  cases  occurred. 
At  this  time  the  second  story  of  the  building,  called  the  wash- 
house,  was  arranged  for  a  hospital,  and  patients  conveyed  there 
as  soon  as  attacked.  For  several  days  after  this  the  cases  were  so 
numerous  and  fatal  that  in  the  alarm  and  confusion  no  register 
of  admissions  was  kept.  After  the  7th  of  July  there  is  an  account 
of  ninety-nine  males  admitted,  eighty-seven  of  whom  died ;  and 
one  hundred  and  one  females,  ninety  of  whom  died. 

On  the  13th  the  medical  attendants  recommended  the  erection 
of  two  temporary  hospitals  outside  of  the  walls.  The  workmen 
commenced  on  the  16th,  and  by  the  23d  had  up  two  board  tents 
in  the  field  by  the  gate  as  you  enter  the  lane  from  Darby  Road. 
They  were  occupied  the  same  day  by  twenty  males  and  eight 


MEDICAL  HISTORY  OF  THE  PHILADELPHIA  ALMSHOUSE.  51 

females.  Of  the  former  seventeen  died ;  of  the  latter  three  died. 
Sixty-eight  additional  cases  were  treated  in  the  tents,  of  which 
number  thirty  died.  From  these  data,  which  I  believe  from  per- 
sonal observations  to  be  far  short  of  the  truth,  the  total  number 
of  cases  was  307,  and  the  deaths  229.1  The  disease  disappeared 
about  the  20th  of  August,  at  which  time  these  provisional  hos- 
pitals were  taken  down.  During  much  of  this  time  the  guardians 
could  not  raise  a  quorum  for  the  transaction  of  business,  but  no 
record  remains  of  any  medical  officer  having  left  his  post,  except 
poor  Massenburg,  the  stranger,  who  was  called  I  hope  from  pro- 
bation to  fruition. 

The  sanitary  committee  of  the  board  of  health,  under  the 
impression  that  the  virulence  of  the  disease  in  the  hosj)ital  was  due 
to  improper  diet,  sent  a  communication  to  the  board  of  guardians 
on  that  subject.  The  statements  made  in  their  answer  showed 
that  any  trifling  impropriety  of  this  nature  had  little  to  do  with 
its  prevalence.  The  mode  of  burying  the  dead  was  changed  for 
a  time ;  trenches  were  dug  so  as  to  hold  only  four  coffins,  two 
abreast,  and  twenty-four  inches  apart.  This  space  was  filled  in 
with  dirt,  twenty-five  pounds  of  chloride  of  lime  was  added  to 
each  grave,  and  the  whole  covered  with  four  feet  of  earth. 

In  1854,  a  third  epidemic  of  cholera  prevailed.  It  commenced 
on  the  7th  of  July,  and  attained  its  greatest  fatality  the  last  days 
of  this  month  and  the  beginning  of  August.  Straggling  cases 
of  it  appeared  as  late  as  the  7th  of  November.  During  this 
period  there  were  about  300  cases,  most  of  which  were  treated  in 
the  small-pox  hospital.near  the  gate,  with  the  addition  of  a  wooden 
tent.  On  examining  the  sources  calculated  to  throw  light  on 
the  result,  it  would  appear  150  cases  of  the  number  attacked 
proved  fatal. 

During  the  months  of  January  and  February,  1849,  a  very 
fatal  epidemic  of  puerperal  fever  prevailed  in  the  lying-in  depart- 
ment of  the  house.  I  have  not  been  able  to  ascertain  the  num- 
ber of  cases,  but  am  told  by  a  very  reliable  and  intelligent  nurse 
of  the  house  that  almost  all  attacked  died.  For  four  weeks  the 
wards  were  vacated  and  every  means  used  to  disinfect*  the  place. 

In  1855,  the  disease  again  appeared  and  lingered  in  the  wards 
for  three  months,  carrying  off  almost  all  puerperal  women  at- 
tacked.    Dr.  Penrose,  who  has  some  valuable  tables  in  course  of 

1A  careful  examination  made  after  writing  the  above  shows  255  deaths  to  have  taken 
place. 


52  MEDICAL  HISTORY  OF  THE  PHILADELPHIA   ALMSHOUSE. 

preparation,  informs  me  that  there  have  been  cases  of  this  for- 
midable disease  in  the  obstetrical  department  every  year,  from 
1841  to  1858,  except  the  years  1844  and  1845;  and  that  since  the 
change  in  the  medical  administration  of  the  institution  he  is  not 
cognizant  of  a  single  case  having  occurred.  This  exemption  he 
attributes  to  the  sanitary  measures  advised  by  himself  and  col- 
leagues. 

The  children's  asylum  has  often  been  invaded  by  destructive 
epidemics.  The  first  one  recorded  was  in  April,  1835,  the  year 
after  the  children  were  moved  to  the  present  house.  This  was 
cancruni  oris.  That  the  mortality  was  large  may  be  inferred  from 
a  single  allusion,  in  which  it  is  stated  twenty  children  had  died 
in  nine  days  from  the  disease.  The  existence  of  the  affection  and 
the  fatality  were  in  a  great  measure  due  to  the  very  imperfect 
organization  of  the  department,  Dr.  Hodge,  who  declined  this 
year  to  attend  the  asylum  any  longer,  addressed  the  managers  on 
this  subject,  advising  as  an  act  of  imperative  humanity  an  imme- 
diate attention  to  the  interests  of  this  department.  Among  the 
suggestions  made  were  the  appointment  of  a  resident  physician 
exclusively  for  the  asylum;  the  selection  of  experienced  and 
conscientious  nurses;  more  room  and  ventilation;  and  more 
hospital  convenience. 

The  other  diseases  peculiar  to  this  period  of  life,  which  have 
frequently  from  time  to  time  existed,  are  ophthalmia,  measles, 
and  scarlet  fever. 

On  the  26th  of  November,  1804,  the  managers  arranged  for  the 
first  time  a  diet  table  for  the  use  of  the  house.  By  this  table  every 
pauper  in  the  medical,  surgical  and  incurable  wards  was  allowed 
for 

BEEAKFAST. 

1  pint  of  coffee  or  1  pint  of  chocolate ;  ^  lb.  of  bread. 

DINNER. 

\  lb.  of  meat ;  1  pint  of  soup  ;  1  lb.  of  potatoes ;  ^  lb.  of  bread 

SUPPER. 
1  pint  of  .tea;  \  lb.  of  bread. 
Every  other  pauper  on  Sunday,  Tuesday  and  Thursday  received : 

BREAKFAST. 

1  pint  of  coffee  or  1  pint  of  chocolate ;  \  lb.  of  bread. 


MEDICAL  HISTORY  OP  THE  PHILADELPHIA  ALMSHOUSE.  53 

DINNER. 

I  lb.  of  bread ;  |  lb.  of  meat ;  1  pint  of  soup  ;  1  lb.  potatoes. 

SUPPER. 

\  lb.  of  bread ;  1  pint  of  tea. 
Every  pauper  on  Monday  received  : 

BREAKFAST. 

1  pint  of  coffee  or  1  pint  of  chocolate ;  \  lb.  of  bread. 

DINNER. 

1  lb.  potatoes ;  1  qt.  of  hash ;  J  lb.  of  bread. 

SUPPER. 

1  pint  of  tea ;  \  lb.  of  bread. 
On  Wednesday  and  Friday : 

BREAKFAST. 

1  pint  of  coffee  or  1  pint  of  chocolate ;  \  lb.  of  bread. 

DINNER. 

Mush  at  pleasure ;  3  gills  of  molasses  to  ten  persons. 

SUPPER. 
1  pint  of  tea;  \  lb.  of  bread. 

For  the  lying-in  wards  every  day  in  the  week : 

BREAKFAST. 

I  lb.  of  bread ;  1  qt.  of  coffee  or  chocolate. 

DINNER. 

I  lb.  of  bread  ;  1  lb.  of  potatoes ;  meat  as  ordered  by  physician. 

SUPPER. 

J  lb.  of  bread ;  1  qt.  of  tea. 

In  this  table  there  is  a  fair  amount  of  food  to  each  person,  but 
very  little  variety.  There  is  no  subject  connected  with  the 
administration  of  an  institution  of  this  kind  more  important  than 
the  one  under  consideration.  It  is  adopted  by  many  as  a  fore- 
gone principle  that  the  objects  of  public  charity  should  be  con- 
fined to  the  simplest,  coarsest  fare  in  quality ;  and  in  quantity  as 
moderate  as  may  be  consistent  with  their  needful  support.  (I  may 
add  here  in  parenthesis,  that  I  do  not  make  any  charge  of  such 
views  against  the  board  of  guardians.)  Connected  with  this  sub- 
ject, I  conceive  there  are  very  nice  questions  of  moral  ethics  and 


54  MEDICAL  HISTORY  OP  THE  PHILADELPHIA  ALMSHOUSE. 

political  science  involved.  I  presume,  both  as  regards  clothing 
and  food,  the  justification  is  drawn  from  the  fact  that  the  inmates 
of  these  public  charities  are  compelled  in  consequence  of  their 
misfortunes  being  self-inflicted,  the  result  of  their  own  vices  and 
evil  habits,  and  therefore  they  surrender  any  claims  to  the  pro- 
tection of  society  beyond  that  of  a  mere  support.  This  is  not  the 
place  to  discuss  a  subject  of  such  ample  nature.  Let  me  only 
throw  out  a  few  thoughts  in  passing  which  may  aid  us  somewhat 
in  its  proper  treatment.  What  is  it  which  makes  us  differ  from 
the  most  degraded  inmates  of  this  house?  Nothing;  really 
nothing,  but  the  grace  of  God.  Will  any  one  doubt  that  the  chief 
instrumentalities  concerned  in  giving  him  position,  reputation, 
moral  and  social  standing  in  society,  were  the  influential  opera- 
tions of  parental  care  and  tenderness,  extended  during  those  years 
when  the  human  character  is  as  plastic  as  the  clay  in  the  hands 
of  the  potter,  and  still  later,  when  the  forecast  of  friends  had  pro- 
vided for  personal  comfort,  and  aided  in  the  formation  of  associa- 
tions salutary  and  restraining?  These,  gentlemen,  more  than  any 
natural  endowments,  have  made  you  what  you  are.  Now  look 
on  the  other  side  of  the  picture.  The  vast  .proportion  of  the 
inmates  of  this  house  have  never  enjoyed  such  all-controlling 
agencies.  Born  most  of  them  in  humble  life,  with  perhaps  a 
vicious  training,  thrown  on  the  world  to  their  own  resources 
during  the  most  impressible  period  of  existence,  with  unformed 
characters  called  to  struggle  with  all  the  temptations  incident  to 
a  life  of  obscure  want  and  toil,  and  without  the  sympathy  of  either 
men  or  government,  is  it  a  marvel,  that  with  such  a  moral 
organization  as  the  race  carries  with  it,  these  creatures  should  be 
driven  to  shipwreck  by  the  tempests  which  come  up  from  the 
human  heart  ?  These  considerations  at  least  commend  them  to 
our  generous  sympathy  and  charity,  and  to  this  end  God  has 
wisely  implanted  in  the  human  heart  a  principle  to  compassionate 
misery  and  misfortune  in  all  their  multiform  aspects.  Whenever, 
therefore,  disease  or  decrepitude,  either  of  mind  or  body,  the  result 
though  it  be  of  vicious  habits,  compel  such  to  seek  an  asylum  at 
the  hands  of  their  fellow  beings,  whatever  other  claims  they  may 
have  forfeited  from  law  or  society,  that  to  the  support  of  life  they 
have  not.  The  diet,  therefore,  it  would  seem  reasonable  should  be 
in  quantity,  quality  and  variety,  such  as  is  capable  of  maintain- 
ing the  best  possible  health  consistent  with  a  broken-down  con- 


MEDICAL  HISTORY  OF  THE  PHILADELPHIA  ALMSHOUSE.  55 

stitution.  The  diet  should  be  determined  after  a  careful  study  of 
the  constitutional  characteristics  of  the  population,  prevailing- 
disease,  and  their  usual  complications.  Looking  at  the  subject  in 
an  economical  point  of  view,  that  regimen  will  prove  the  most 
desirable  which  exerts  the  largest  influence  in  keeping  the  inmates 
out  of  the  hospital,  as  by  the  report  for  1862  it  will  conserve  the 
difference  between  seventy-two  cents  and  two  dollars. 

In  conclusion,  gentlemen,  it  is  difficult  to  over-estimate  the 
importance  of  this  institution,  to  either  the  profession  or  the  com- 
munity. To  say  nothing  of  the  multiform  types  of  destitution 
and  want  which  it  meets  and  relieves,  look  at  the  field  which  it 
offers  to  the  disciple  of  medicine,  and  which  no  man  will  lightly 
esteem  who  contemplates  the  prosecution  of  his  profession  with 
a  conscience  void  of  offence  towards  God  and  man.  There  is  a 
hospital,  in  which  over  eight  thousand  cases  of  disease  are  treated 
annually;  a  children's  asylum,  offering  illustrations  of  all  the 
complaints  incident  to  this  period  of  life ;  and  there  is  an  obstet- 
rical department,  in  which  as  many  as  seven  cases  of  labor  have 
occurred  in  twenty-four  hours,  and  where  in  the  last  thirteen 
years  over  two  thousand  six  hundred  children  have  been  born. 
One  year  industriously  spent  in  this  institution  will  yield  in 
medical  experience,  the  fruits  of  ten  years  gathered  from  an 
ordinary  practice.  But  to  place  the  statement  in  another  form :  a 
graduate  of  medicine  faithfully  improving  for  a  single  year  his 
opportunity  for  study  of  disease  in  the  wards  of  the  Philadelphia 
Hospital,  will  be  better  fitted  to  assume  the  responsibilities  of  his 
profession,  than  one  who  labors  ten  years  in  an  ordinary  city  or 
country  practice. 


REMINISCENCES  OF  THE  PHILADELPHIA  HOSPITAL.1 


By  ALFEED  STILLE,  M.D. 


Gentlemen  : — Let  me  thank  you  for  the  compliment  you  have 
paid  me  in  making  me  the  first  president  of  your  association.  I 
hope  that  it  may  nourish  for  many  years  to  come,  and  bind  all 
its  members  to  sustain  the  past,  present,  and  future  reputation  of 
the  great  hospital  in  which  we  have  all  had  the  honor  and  advan- 
tage of  cultivating  the  art  of  all  arts,  the  "  art  of  healing."  I 
shall  make  no  attempt  to  present  to  you  the  history  of  the  alms- 
house hospital,  for  this  work  was  thoroughly  done  by  Professor 
Agnew  in  an  introductory  lecture  to  his  clinical  course  at  the 
hospital  in  1862 ;  nor  shall  I  pretend  to  do  more  than  retrace  for 
you  an  outline  of  some  of  the  features  of  the  institution  as  I 
knew  it  more  than  half  a  century  ago.  The  memories  of  youth 
are  apt  to  outlive  those  of  middle  age  ;  and  certainly  many  events 
of  my  first  hospital  experience  are  as  clear  and  vivid  in  ni}T  mind 
to-day  as  if  they  had  occurred  but  a  year  ago,  while  not  a  few 
of  the  intervening  ones  have  faded  quite  away. 

In  1836,  the  buildings  composing  the  almshouse,  except  the 
additions  to  the  southernmost  one,  were  substantiallj7  the  same 
as  now,  but  the  uses  of  some  of  them  were  different.  The  south- 
ern building  was  then  entirely  occupied  by  the  hospital — its  east- 
ern half  by  the  male,  its  western  half  by  female  patients — while 
in  the  centre  was  the  lecturing  and  operating  amphitheatre.  The 
east  return  wing  was  filled  with  insane  males,  and  the  west  with 
insane  females.  The  apothecary's  shop  was  on  the  ground  floor  of 
the  same  building.  The  lying-in  wards  were  in  the  west  end  of  the 
building  forming  the  northern  side  of  the  quadrangle,  and  the 
children's  asylum  in  the  corresponding  part  of  the  east  end. 

1Address  made  by  Dr.  Stille,  as  first  president  of  the  association  of  the  ex-residents  of  the 
Philadelphia  Hospital,  December  6,  1887,  at  the  dinner  given  by  them  at  the  Bellevue  Hotel, 
Philadelphia,  at  which  sixty  were  present.  A  brief  account  of  this  association  will  be  given 
later. 

(56) 


REMINISCENCES    OF    THE    PHILADELPHIA    HOSPITAL.  0, 

I  lived  in  the  children's  asylum,  of  which  I  had  special  charge, 
although  I  had  also  charge  of  medical  and  surgical  wards  in  the 
hospital  itself.  If  I  were  asked  what  half-year  in  my  ]  >r<  Sessional 
life  was  the  happiest,  I  should  reply  the  period  that  I  lived  in 
that  asylum.  I  occupied  a  vast  chamber  that  looked  out  upon 
green  fields  and  a  fair  river,  with  a  view  of  the  city  beyond  them. 
I  had  no  companions  to  disturb  me:  I  was  aflame  with  the  desire 
of  knowledge,  and  all  my  time  was  eagerly  devoted  to  the  study 
of  disease  and  of  books. 

The  board  of  manager-  of  that  day  was  certainly  not  composed 
of  very  refined  men,  but  they  were,  according  to  their  lights, 
competent,  and  very  different  from  the  vulgar,  corrupt  and  venal 
body  which  in  later  years  mismanaged  the  institution.  I  can 
recall  several  of  them  who  were  conspicuous  for  exhibiting  their 
power  in  season  and  out  of  season,  not  only  over  the  paupers  and 
patients,  but  over  the  medical  resident-  also.  Ignorance  and 
coarseness  have  a  natural  repulsion  for  knowledge  and  refinement, 
and  the  feeling  is  more  or  less  reciprocated.  Very  seldom,  indeed, 
is  there  a  cordial  harmony  between  hospital  managers  and  resi- 
dent physicians.  The  exercise  of  power  is  as  dear  to  the  one  as 
intolerance  of  it  is  natural  to  the  other.  The  one  lacks  sympathy 
and  the  other  humility. 

It  would  hardly  be  credited,  were  it  not  unquestionably  true, 
that  this  great  clinical  school  was  closed  for  nearly  ten  years, 
because  in  lv4o  the  resident  physicians  were  shocked  by  a  cock- 
roach upon  their  dining  table,  and  not  obtaining  redress  ;<  >r  their 
offended  delicacy,  they  incontinently  resigned.  One  cannot  but 
pity  a  susceptibility  that  would  allow  such  an  incident  to  imperil 
the  success  of  a  professional  life.  But  we  cannot  expect  to  find  old 
heads  on  young  shoulders,  nor  even  the  most  righteous  cause  to  be 
temperately  promoted. 

Another  incident  may  be  used  in  illustration.  The  president 
of  the  board  of  guardians  was  the  bugbear  of  the  whole  es- 
tablishment, from  the  steward  down  to  the  most  abject  pauper 
who  had  no  home  but  the  almshouse.  It  was  natural  that 
some  of  the  quick-tempered  and  high-minded  house-physicians 
should  resent  the  pompous  tyranny  of  this  man.  and  occasi* 
enough  for  doing  so  occurred.  Of  these  I  may  recall  one  or  two. 
South  of  the  hospital  in  those  days  was  a  large  flower  and  fruit 
garden  which  the  guardians  reserved  for  the  sole  enjoyment  of 


58  REMINISCENCES  OF  THE  PHILADELPHIA  HOSPITAL. 

their  senses  and  appetites,  and  which  all  other  persons,  including 
the  resident  physicians,  were  as  strictly  forbidden  to  enter  as  were 
Adam  and  Eve  to  return  to  the  garden  of  Eden.  One  of  the 
residents  it  seems,  not  having  the  fear  of  the  guardians  before  his 
eyes,  had  the  audacity  to  enter  the  sacred  precincts  and  appropriate 
a  few  peaches  and  roses.  A  mighty  clamor  followed,  only  to  be 
compared  to  the  outburst  of  Mr.  Squeer's  wrath  when  Oliver  asked 
for  "more."  I  do  not  remember  what  the  upshot  was,  but  cer- 
tainly not  "  the  brown  paper  parcel  full  of  groans  "  which  was  the 
net  result  of  the  English  school  boy's  flogging.  My  impression 
is  that  a  special  edict  was  issued  against  trespass  upon  paradise, 
and  signed  with  the  vermilion  pencil  of  the  great  Mogul  of 
Blockley  almshouse. 

In  those  days  the  residents  boarded  at  the  steward's  table; 
the  meals  were  always  good,  and  on  Sundays  and  on  the  days 
when  the  board  of  guardians  met,  they  seemed  to  us  both  sump- 
tuous and  abundant.  On  Sunday,  when  everything  and  every- 
body is  later  than  usual,  it  happened  that  the  residents  were  not 
always  punctual  to  the  dinner  hour;  but  the  president  of  the  board 
and  some  of  his  colleagues,  who  were  not  apt  to  be  behindhand 
at  the  feast,  were  so  annoyed  by  the  young  men's  unpunctuality, 
that  they  issued  an  ukase  proclaiming  that  all  the  residents  who 
did  not  arrive  within  a  certain  time  should  be  denied  a  passage 
through  the  gates  in  the  yard  fences,  and  be  thereby  compelled 
to  reach  the  steward's  quarters  by  passing  through  the  paupers' 
outwards.  This  indignity  was  hotly  resented,  and  one  summer 
day  a  resident  physician,  being  detained  by  his  duties,  found  the 
yard  door  closed  between  him  and  his  dinner,  and  was  told  that 
he  must  reach  the  steward's  apartments  through  the  paupers' 
wards.  After  parleying  for  some  time,  and  then  sending  a  request 
to  the  president  of  the  board  to  permit  his  passage,  which  was 
denied,  he  retreated  a  little,  and  with  a  rush,  kicked  the  door 
open,  and  made  his  way  to  the  dining-room,  where  he  reported  to 
the  president  of  the  board  what  he  had  done.  This  gentleman 
was  so  amazed  that  he  made  no  reply,  and  the  combative  resident 
was  never  called  to  account  for  taking  the  law  into  his  own  hands. 

As  I  have  said  already,  I  had  special  charge  of  the  children's 
asylum,  and  lodged  in  it.  It  was  a  very  interesting  field  for  me 
from  a  humanitarian  as  well  as  a  medical  point  of  view.  A  hun- 
dred or  more  children  were  sheltered  there  on  their  way  to  the 


REMINISCENCES  OF  THE  PHILADELPHIA  HOSPITAL.  59 

early  grave  to  which  most  of  them  were  destined.  Illegitimate 
and  other  outcasts  formed  the  majority,  and  ophthalmia,  that 
curse  of  children's  asylums,  made  of  them  a  blear-eyed,  puny  crowd, 
most  pitiable  to  see.  I  soon  became  convinced  of  the  causes  that 
produced  the  crippling  and  mortality  of  these  outcasts  and  waits. 
I  pointed  out  to  the  committee  of  the  board  how  the  disease  was 
disseminated  by  the  children  washing  in  the  same  basins  and 
using  the  same  towels,  and  how  it  was  maintained  by  their  hav- 
ing no  shaded  places  for  exercise  in  the  open  air,  and  also  by  the 
insufficient  food  permitted  them :  for  if  the  soup  which  they  re- 
ceived one  day  was  nutritious,  the  meat  of  which  the  soup  had 
been  made,  and  which  forrnecl*their  dinner  on  the  following  day. 
must  necessarily  be  nearly  devoid  of  nutriment.  But.  of  course, 
the  committee  on  the  children's  asylum  and  the  guardians  knew 
better  than  I.  and  at  the  time,  at  least,  nothing  was  done  to  cor- 
rect this  wrong.  In  my  day  Dr.  Joseph  Pancoast  was  the  attend- 
ing physician  of  the  children's  asylum,  and  it  is  plea-ant  to  me 
to  recall  the  cordial  relations  which  I  there  began  with  him. 

I  might  digress  here  to  speak  of  my  colleagues  in  the  hospital, 
and  of  some  of  those  who  immediately  preceded  or  followed  me. 
The  list  of  them  as  I  remember  it  was  the  following  :  Asa  Frisby, 
of  Mississippi :  Thomas  J.  Turpin,  of  Maryland  :  John  H.  From- 
berger,  Robert  R.  Porter,  and  Louis  P.  Bush,  of  Delaware  :  William 
Elmer,  of  New  Jersey ;  William  P.  Johnston,  of  Georgia,  and  later, 
of  Washington,  D.  C:  Robert  Morris,  Benjamin  Stille,  Joshua  M. 
AVallace,  Henry  S.  Patterson,  Charles  Bell  Gibson,  Edmund  C. 
Evans,  Charles  N.  Ege,  and  John  B.  Biddle,  of  Philadelphia  :  and 
Joseph  Walker,  of  Bermuda. 

Of  these  there  survive  only  Dr.  Bush.  Dr.  Elmer,  and  Dr. 
Morris.  The  last  never  became  a  practitioner,  and  after  a  few 
years  pursued  literary  rather  than  medical  studies  :  but  Dr.  Bush 
was  long  a  leading  practitioner  of  his  native  town :  and  Dr.  Elmer, 
of  Bridgeton,  X.  J.,  and  the  surrounding  region.  Of  the  rest. 
Johnston,  Wallace,  Gibson,  Patterson  and  Biddle  obtained  dis- 
tinction as  teachers  of  medicine,  and  the  others  were  successful 
in  practice.  I  have  never  doubted  that  they  all  owed  their 
success  in  a  very  large  measure  to  two  of  the  gentlemen  who 
were  then  attending  physicians  to  the  hospital,  and  I.  for  my  own 
part,  am  happy  to  recognize  my  share  of  this  standing  debt. 
These  two  physicians  were  William  Woods  Gerhard  and  Caspar 


60  REMINISCENCES  OF  THE  PHILADELPHIA  HOSPITAL. 

Wistar  Pennock.  Both  had  studied  in  Europe  with  great  dis- 
tinction, and  had  enjoyed  unusual  opportunities  for  clinical  study 
at  home  and  abroad. 

Dr.  Pennock  by  his  experiments  upon  the  physiological  action 
and  sounds  of  the  heart,  and  by  his  clinical  researches  in  cardiac 
disease,  preceded  other  American  physicians  in  this  field,  and 
inspired  with  his  own  noble  enthusiasm  all  who  became  his 
pupils.  No  nobler,  purer,  more  unselfish  man  ever  lived ;  but 
he  was  lost  to  medicine  many  years  before  his  death  by  the  steady 
progress  of  a  disease  of  the  spinal  marrow.  His  colleague,  Dr. 
Gerhard,  had  been  a  resident  physician  of  the  almshouse  hospital 
while  it  was  still  in  the  centre  of  -the  city,  and  the  great  clinical 
school  of  Philadelphia.  In  its  wards  he  made  numerous  important 
investigations,  and  among  them  experiments  on  the  endermic 
action  and  absorption  of  medicines.  Thenqe  he  went  to  Paris 
well  accoutred  for  the  study  of  clinical  medecine  under  Louis ; 
and  among  other  fruits  of  his  Parisian  studies  he  contributed 
largely  to  the  pathology  of  tubercular  meningitis. 

His  familiarity  with  typhoid  fever  gained  in  Paris,  and  with 
typhus  fever  which  he  studied  in  Great  Britain,  prepared  him 
for  a  thorough  investigation  of  them  on  his  return  to  this  coun- 
try, and  especially  for  becoming  the  historian  of  the  epidemic  of 
typhus,  which  furnished  hundreds  of  patients  to  the  Philadelphia 
Hospital  in  183G.  In  spite  of  the  extreme  contagiousness  of  the 
disease,  and  the  great  mortality  which  kept  everyone  busy  with 
examinations  post-mortem,  the  enthusiasm  of  master  and  pupils 
knew  no  bounds.  The  history  of  this  epidemic  was  afterwards 
published  by  Drs.  Gerhard  and  Pennock,  and  to  this  day  remains 
the  earliest,  as  well  as  one  of  the  most  perfect  and  original  demon- 
strations of  the  specific  differences  between  typhus  and  typhoid 
fever. 

Dr.  Gerhard's  bedside  instruction  in  physical  diagnosis  was  also 
followed  with  zeal,  and  happy  did  his  pupils  esteem  themselves 
in  having  as  a  teacher  one  who  had  drawn  his  knowledge  from 
the  very  fountain  head  in  Paris.  For  in  those  days  there  was  a 
far  greater  gulf  than  now  fixed  between  those  whose  knowledge 
had  been  gained  abroad  and  those  whose  education  had  been 
domestic  only. 

At  that  time  also,  and  through  Dr.  Gerhard's  skill,  a  radical 
reform  occurred  in  the  treatment  of  mania-a-potu  and  delirium 
tremens.     Indeed,  to  him  and  to  the  wards  of  the  Philadelphia 


REMINISCENCES  OF  THE  PHILADELPHIA  HOSPITAL.  61 

Hospital  is  due  the  abandonment  of  the  murderous  use  of  opium 
in  those  affections  and  the  substitution  for  it  of  well  seasoned  food 
and  alcohol,  generally  in  the  form  of  porter.  He  was  enabled  to 
prove  that  both  the  primary  and  the  secondary  effects  of  drunken- 
ness tend  to  terminate  in  cure,  and  that  they  ought  never  to  be 
fatal  in  uncomplicated  cases. 

Among  the  patients  who  came  periodically  under  his  care  for 
such  effects  of  intemperance  was  a  certain  M.D.,  a  man  of  good 
education  and  some  wit,  who  was  so  charmed  by  the  new  method 
that  he  exhaled  his  pleasure  in  the  following  doggerel  verses. 

THE  WONDERFUL  BOOK, 

OR  JIM  CROW,    DAVY   CROCKETT,   ASD  MAJOR  JACK    DOWNING   SWEPT   FROM  THE  READING 
WORLD  IN  A  BLAZE  OF  SCIENCE  BY   A.    C.   DRAPER,   M.D. 

Ye  knights  of  the  lancet  tor  knowledge  prepare  ; 
A  brother  of  talents  and  learning  most  rare 
Has  determined  no  longer  his  fingers  to  crook, 
But  enlighten  the  world  with  a  wonderful  hook. 

Six  months  is  the  time  he  has  wisely  assigned 
To  usher  to  light  this  great  birth  of  his  mind  ; 
Some  granny  bookseller  accoucheur  will  act, 
As  deliv'ring  a  doctor  requires  much  tact. 

In  a  fit  of  the  horrors  the  book  was  begot, 
That  from  mania-a-potu  will  rescue  each  sot, 
And  save  almshouse  doctors  the  trouble  and  care 
Of  prescribing  for  those  mania  fills  with  despair. 

And  who  can  dilate  on  disease  of  the  Cells 
Like  him  who  so  oft  in  their  solitude  dwells, 
And  worships  fair  science  within  their  bare  walls, 
Unmindful  of  home  or  his  patients'  loud  calls  ? 

Ye  men  of  cold  water,  avaunt !  quit  the  field  ! 
To  brandy  and  porter  he'll  force  you  to  yield  ; 
And  as  to  the  swill  you  have  christened  hop  tea, 
With  the  stomach  he  swears  it  will  never  agree. 

'Bout  hops  he  is  certain  you're  sadly  at  fault ; 
'TAvere  better  to  brew  them  at  once  with  good  malt, 
The  prescription  no  patient  would  ever  bewail 
If  it  came  in  the  shape  of  good  Albany  ale. 

Should  the  doctor  once  more  for  humanity's  sake 
Get  blue,  on  his  system  more  lessons  to  take, 
It  is  hoped  the  physician  who  'tends  to  his  case, 
To  cure  him  with  brandy  the  chance  will  embrace. 


G2  KEMINISCENCES  OF  THE  PHILADELPHIA  HOSPITAL. 

And  who,  to  teach  others,  such  perils  would  court, 
Treating  life  as  a  thing  only  given  for  sport? 
Not  one  out  of  twenty  his  studies  would  try, 
Not  one  in  a  thousand  for  science  would  die- 
When  he's  quite  convalescent  and  home  would  retreat. 
Never  try  to  regale  him  with  tea  made  of  meat ; 
For  nought  to  his  stomach  affords  such  relief 
As  a  bottle  of  porter  and  a  pound  of  good  beef. 

And  the  names  of  the  doctors  who  please  him  will  grace 
In  letters  of  gold  his  book's  learned  preface  ; 
Prescribers  who  value  a  medical  fame 
Must  feed  hini  with  brandy  to  get  a  good  name. 

At  the  period  of  which  I  am  speaking  blood-letting  was  still  in 
vogue.  The  absurd  theories  of  Broussais  were  still  dominant, 
and  the  "  hand-over-hand  bleedings  "  of  Bouill  I  soon  afterwards 
witnessed  in  Paris.  I  may  truly  say  that  when  I  think  of  blood- 
letting at  the  Philadelphia  Hospital  fifty  years  ago,  I  shudder — 
horresco  ref evens.  Adults  were  bled  in  all  manner  of  diseases  by 
venesection,  cups  and  leeches,  and  even  the  miserable  cachectic 
children  did  not  escape  the  bloody  sacrifice.  I  have  seen  a  chronic 
lunatic  strapped  in  a  so-called  "  tranquillizing  chair  "  and  bled  ad 
deliquium.  To  this  day  I  have  on  my  own  person  a  scar  that 
attests  my  own  ignorance  and  the  presumption  of  one  of  my 
equally  ignorant  colleagues,  who  bled  me  for  some  trifling  epheme- 
ral fever  that  did  not  even  confine  me  to  bed.  From  the  begin- 
ning of  my  own  private  practice  in  1841  to  the  present  day,  I 
have  not  practised  venesection  a  dozen  times. 

The  management  of  the  insane  department  at  the  time  of  my 
service  was  as  devoid  of  medical  knowledge  and  humanity  as  was 
possible,  and  there,  as  also  in  institutions  that  falsely  laid  claim 
to  being  pioneers  in  the  humanitarian  treatment  of  the  insane, 
cruel  repression  took  the  place  of  rational  and  humane  manage- 
ment. I  have  still  vividly  in  my  memory  pictures  of  raving 
maniacs  in  straight-jackets  strapped  to  their  bedsteads  or  bound 
to  massive  chairs,  while  bladders  of  ice  were  applied  to  their  shorn 
scalps.  I  still  see  before  me  the  narrow  shelterless  yards  of  the 
hospital  filled  with  a  mingled  crowd  of  gibbering  lunatics,  many 
of  them  wearing  leather  muffs,  while  others  wandered  in  melan- 
choly vacuity  around  their  narrow  prison — with  nothing  to  occupy? 
nothing  to  amuse,  nothing  to  improve  them. 


REMINISCENCES  OF  THE  PHILADELPHIA  HOPSITAL.  63 

So  profoundly  and  painfully  was  I  impressed  by  these  inhuman 
horrors,  that  I  prepared  for  the  grand  jury  of  the  time  a  paragraph 
for  insertion  in  their  presentment,  urging  the  legislature  to  pro- 
vide for  the  better  accommodation  and  treatment  of  the  insane  in 
the  almshouse.  It  was  only  many  years  afterwards  that  any  effi- 
cient measures  were  instituted  for  even  lessening  this  blot  upon 
the  name  of  a  city  that  piques  itself  on  the  abundance  of  its  good 
works. 

I  have  but  lightly  touched  upon  some  of  the  points  that  are 
most  prominent  in  my  memory  of  my  first  hospital  residence. 
Many  others  are  recalled  by  them — events,  names,  persons,  that 
had  apparently  been  forgotten ;  but  I  resist  the  temptation  to 
make  the  procession  pass  before  you.  I  have  already  trespassed 
too  long  upon  your  time ;  and  so,  thanking  you  for  your  courteous 
patience,  I  leave  to  others  the  sad  but  pleasing  duty  of  piecing 
out  my  reminiscences  and  continuing  them  with  their  own. 


ADDITIONAL  REMINISCENCES  OF  THE  PHILADEL- 
PHIA HOSPITAL.1 


By  ALFRED  STILLE,  M.D. 


Mr.  President  and  Gentlemen  : — I  rise  to  respond  to  the  toast 
you  have  heard  read,  but  let  me  add,  it  is  under  compulsion — 
moral  compulsion  I  mean,  which  is  sometimes  more  constraining 
than  physical  force.  Your  committee  of  arrangements  was  good 
enough  to  say  that  my  semi-centennial  reminiscences  of  last  year 
gave  pleasure  to  the  guests,  and  they  founded  thereon  a  sugges- 
tion that  more  of  the~same  sort  would  be  acceptable.  But  they 
probably  forgot  that  there  is  a  natural  limit  to  such  recollections ; 
that  they  cannot  be  produced  at  will,  and  that  between  my  friend 
and  ancient  colleague,  Dr.  Bush,  and  myself,  the  garner  had  been 
pretty  thoroughly  emptied.  Indeed,  it  seems  to  me  that  any  slight 
addition  I  might  make  to  the  picture  will  be  flat  and  meaningless 
if  torn  from  its  original  connections,  just  as  a  garment  would  be 
if  removed  from  the  body  to  which  it  belongs. 

And  yet  all  of  you  who  have  passed  through  the  discipline  of 
our  great  hospital,  even  recently,  must  have  observed  that  besides 
the  atmosphere  of  science  and  art,  and  besides  the  discipline  and 
the  comradeship,  which  together  constituted  its  training  as  a  pro- 
fessional school,  and  which  cannot  fail  to  shape  and  color  your 
whole  career,  there  are  some  others  which  cling  to  the  memory 
and  even  to  the  senses,  and  are  strangely  powerful  to  resuscitate 
impressions  long  ago  received  and  apparently  extinct.  Philoso- 
phers have  contended  that  our  sensations  are  most  numer- 
ous and  permanent,  some  when  we  receive  them  through  the 
sight,  and  others   through  the  hearing ;   but  I  am   disposed  to 

1  Address  made  by  Dr.  Stille  at  the  association  of  the  ex-residents  of  the  Philadelphia 
Hospital,  December  4,  1888,  at  the  dinner  given  by  them  at  the  Bellevue  Hotel,  Philadelphia. 
Response  to  the  toast,  "  The  Residents  of  Auld  Lang  Syne." 

(64) 


REMINISCENCES  OF  THE  PHILADELPHIA  HOSPITAL.  65 

think  the  olfactory  seuse  retains  longest  of  all  the  impressions 
made  upon  its  organs. 

It  seems  to  me  that  the  almshouse  smell  must  be  immortal,  or 
can  only  "  by  annihilation  die."  It  is,  or  was,  a  smell  sui  generis, 
for  every  hospital  has  its  specific  smell.  Certainly  it  has  no 
resemblance  to  the  smell  of  rose,  or  violet,  or  lily,  nor,  on  the 
other  hand,  is  it  borrowed  of  asafcetida  or  cacodyl.  It  is  a  smell 
that  one  may  recognize  as  a  familiar  acquaintance  in  the  prisons 
of  Naples  or  in  the  Edinburg  infirmary.  The  smell  of  a  civil  or 
military  hospital  has  its  characteristics,  but  the  effluvium  of  a 
pauper  almshouse  hospital  has  a  much  intenser  quality.  It  is 
compounded  of  the  exhalations  of  the  habitually  great  unwashed  '■> 
of  effluvia  generated  by  the  decay  of  the  sick,  and  the  decomposi- 
tion of  their  excretions  ;  of  the  stale  or  rotting  food  that  has  been 
accumulated  surreptitiously  and  hidden  away;  of  steam  from  the 
meat  caldron  and  emanations  from  the  bakehouse  or  the  fresh 
bread;  from  the  heaps  of  musty  old  boots  and  festering  garments 
thrust  out  of  sight  and  fermenting  in  unopened  closets;  and  then, 
mingling  with  and  overlaying  all  of  these,  a  certain  medicinal  odor 
which  may  be  traced  to  the  accumulation  of  tinctures,  and  mix- 
tures, and  unguents,  and  plasters,  upon  the  bedside  tables  of  many 
patients.  It  is  not  what  perfumers  call  a  bouquet,  which  plays  a 
gamut  of  delight  upon  the  olfactory  sense,  but  an  acrid,  foetid, 
sickening,  musty,  fusty,  and  above  ail,  frowsy  smell,  more  com- 
plex in  its  combination  than  the  most  ingenious  compound  of 
the  perfumer's  art,  It  is  the  pervading  genius  loci,  and  never  is 
to  be  encountered  outside  of  the  walls  of  a  pauper  hospital.  You 
cannot  sweeten  it ;  you  cannot  altogether  expel  it. 

"You  may  scrub,  you  may  ventilate  wards  as  you  will, 
But  the  smell  of  the  almshouse  will  cling  to  them  still." 

It  can  "  only  by  annihilation  die ;"  by  a  fire  that  should  consume 
the  whole  building.     But  the  remedy  is  too  cqstly. 

No  doubt  in  progress  of  time  this  odor  has  lost  something  of 
its  acrimony,  for  during  my  service  as  a  visiting  physician 
(1866-72)  its  pungency  had  perceptibly  declined.  This  improve- 
ment was  immediately  due  to  two  members  of  the  board  of 
guardians.  One  was  its  president,  John  M.  Whitall,  a  plain  man 
of  strong  common  sense,  an  expert  in  the  art  of  ventilation, 
and  a  guardian,  who,  with  some  of  his  colleagues,  kept  the  board 


66  REMINISCENCES  OF  THE  PHILADELPHIA  HOSPITAL. 

from  plunging  into  the  quagmire  of  politics.  The  other  was  Mr. 
Parker,  an  iconoclastic  reformer,  whose  zeal  sometimes  outran 
his  discretion,  but  whose  efforts  to  reform  were  so  persistent 
that  he  came  to  be  felt  as  a  thorn  in  the  guardians'  side. 
They  could  not  tolerate  his  continual  pricking,  and  when  his  term 
of  service  expired  they  took  efficient  means  to  prevent  his 
re-appointment. 

As  everybody  knows,  one  gets  used  to  foul  smells,  and  at  last 
ceases  to  notice  them.  Indeed,  some  persons  seem  rather  to  thrive 
in  a  contaminated  atmosphere.  So  it  is  said  that  scavengers  and 
night-soil  workers  acquire  an  immunity  to  certain  diseases.  In 
like  manner,  the  inhabitants  of  the  Nile  and  the  Mississippi 
basins  are  said  to  prefer  the  muddy  water  of  those  streams  to 
clear  and  sparkling  mountain  brooks.  But  it  does  not  follow  that 
the  ignorant  and  stupid  and  careless  should  be  allowed  to  sacri- 
fice either  themselves  or  those  who  are  under  their  care.  I  cannot 
doubt  that  the  day  will  come  when  it  shall  no  longer  be  thought 
any  more  consistent  with  humanity  and  benevolence  that  alms- 
house paupers  and  hospital  patients  and  their  physicians  and 
attendants  should  breathe  a  noisome  and  pestilent  air,  than  it 
now  is  to  chain  maniacs  to  their  cell  walls,  or  strap  them 
in  "  tranquillizing   chairs,"  as  was   not   long   ago   the   custom. 

Looking  back  at  the  far  distant  period  when  I  was  a  resident 
physician  of  the  Philadelphia  Hospital,  I  am  as  much  surprised 
at  the  definite  portraits  in  my  memory  of  certain  of  the  inmates  of 
that  time,  as  I  am  at  the  distinct  impressions  retained  by  my 
olfactory  senses.  Although  I  have  seen  scarcely  any  of  them  for 
half  a  century,  I  think  that  if  I  were  a  draughtsman,  I  could 
outline  the  faces  and  figures  of  many  among  them,  beginning 
with  steward  Stockton,  whose  grave  and  weary,  but  benevolent 
features,  were  harclty  ever  lighted  by  a  smile,  and  ending  with  the 
"  Captain,"  who  reigned  in  the  region  of  the  dead,  and  enlivened 
his  lugubrious  occupation  by  frequent  trials  of  strength  with 
Bacchus,  in  which  the  man  was  uniformly  worsted  by  the  fiery 
god.  It  would  seem  that  there  must  be  some  natural  connection 
between  dead-house  men  and  spirits,  for  I  remember  that  one 
winter,  while  I  was  a  visiting  physician,  the  river  was  full  of  ice, 
and  the  dead-house  official  of  the  time  not  clearly  distinguishing 
between  it  and  terra  firma,  plunged  into  the  water  and  was 
drowned.     His  body  was  brought  to  the  house  the  next  day.     It 


REMINISCENCES  OF  THE  PHILADELPHIA  HOSPITAL.  67 

had  a  bright,  ruddy  color,  and  all  the  limbs  were  placed  as  if  the 
man  had  died  in  the  act  of  climbing.  So  life-like  a  corpse  I 
never  beheld. 

Among  the  nurses,  I  most  distinctly  remember  the  matron  of 
the  children's  hospital,  where  I  lived.  She  was  a  quiet-spoken, 
motherly  person  ;  but  the  zeal  of  her  office  did  not  eat  her  up. 
She  had  a  too  wholesome  dread  of  daring  to  have  an  opinion  in 
the  presence  of  the  committee  of  the  board.  She  had  two  acolytes, 
Nancy,  the  nurse,  who  nearly  lost  her  sight  by  contagious 
ophthalmia,  and  afterwards  entered  the  service  of  one  of  the  phy- 
sicians of  the  house  and  brought  up  all  his  children ;  and  Jane 
(I  think  that  was  her  name),  who  had  that  stupid,  astonished 
good  nature  peculiar  to  some  of  her  country-folk. 

Then  there  was  the  big,  burly,  apoplectic  looking  head  nurse 
of  the  male  insane  department.  He  enjoyed  the  monopoly  of 
leeching  and  cupping  all  over  the  house.  It  shakes  my  faith  in 
medicine  to  think  what  sanguinary  floods  we  then  believed  it 
necessary  to  shed!  This  man  ruled  his  own  particular. kingdom 
with  an  impartiality  of  severity  most  edifying  to  those  who 
believed  that  maniacs  are  possessed  with  devils. 

I  think  I  can  see  old  mother  Hardy  of  the  female  venereal  ward 
peering  through  the  big,  round  glasses  of  her  spectacles ;  a  stern, 
yet  kindly  shepherdess  of  poor  sheep  that  had  gone  astray,  and 
found  more  thorns  than  flowers  in  the  primrose  paths  of  pleasure. 
Ah  well!  these  reminiscences  are,  I  know,  less  interesting  to 
you  than  to  him  who  gathers  them,  for  he  was  himself  a  part  of 
them.  They  have  been  woven  into  his  life,  and  none  but  himself 
can  understand  or  thoroughly  feel  them. 

And  let  me  be  allowed  to  say  to  my  younger  brothers,  do  not 
let  the  impressions  of  your  hospital  life  ever  grow  dim.  Recall 
them  for  the  entertainment  of  your  friends  and  for  your  own 
solace.  Preserve  them  for  the  time  when  you,  like  myself,  shall 
have  rested  from  the  more  active  and  arduous  labors  of  your  pro- 
fession ;  and  then 

"Forsan  et  hsec  olim  meminisse  juvabit." 

[During  the  last  few  years  the  almshouse  smell  has  almost  disappeared,  a  result  due  to  the 
earnest  efforts  of  the  governing  board,  the  superintendent,  and  physicians-in-ehief,  aided  by 
the  medical  board  and  the  nurses'  training  school.  The  erection  of  improved  water  closets 
with  proper  sewer  connections  has  had  a  most  wholesome  effect. 


REMINISCENCES  OF  THE  PHILADELPHIA  H03PITAL, 

AND  REMAPvKS  ON  OLD-TIME  DOCTORS 

AND  MEDICINE. 


By  LEWIS  P.  BUSH,  M.D. 


Mr.  President  and  Fellow-Members  of  the  Association 
of  Ex-Resident  and  Resident  Physicians  of  Blockley  Hospi- 
tal:— One  year  ago  we  met  to  talk  over  the  scenes  and  inci- 
dents, "  grave  and  gay,"  of  the  Blockley  Hospital  within 
the  last  half  of  the  century ;  some  fresh  and  strong  in  memory, 
others  fading  into  the  dim  vista  of  a  "  long  time  ago."  A  few  of 
1837  still  remain — how  many  of  the  years  before,  if  any,  I  have 
no  knowledge.  Should  the  roll  of  1836-37  be  called,  who  could 
respond  but  Stille  and  Elmer,  and  I  presume  Morris,  the  former 
of  whom  I  am  happy  to  find  with  us  this  evening.  What  shall 
we  say  of  Frisby,  Johnson,  Fromberger,  Gibson,  Ege,  Walker, 
Wallace  and  Boyer?  They  are  not  here — most  of  them,  as  I 
believe,  gone  beyond  the  sound  of  human  call.  Whether  joyful 
or  sorrowful,  may  I  not  spend  a  few  moments  in  passing  a  simple 
tribute  to  the  memory  of  several  of  them  ? 

William  P.  Johnson,  of  Savannah,  Georgia,  was  graduated  in 
the  University  of  Pennsylvania  in  1836,  settled  in  his  native 
place,  but  afterward  in  Washington,  D.  C,  where  he  became  en- 
gaged in  a  large  and  successful  practice,  and  became  professor  of 
obstetrics  in  the  Washington  College,  which  place  he  filled  for 
twenty  years.  He  died  about  the  year  1880,  broken  down  by 
the  labors  of  his  profession,  and  lamented  by  a  large  circle  of 
friends,  acquired  by  kind  and  unremitting  professional  attention. 

Address  made  by  Dr.  Bush,  of  Wilmington,  Delaware,  at  the  dinner  of  the  association  of 
ex-resident  physicians  of  the  Philadelphia  Hospital,  December  4, 1888.  Dr.  Bush  and  Dr.  Stille 
were  resident  physicians  in  1836,  and  are  probably  among  the  oldest,  if  not  the  oldest,  living 
ex-residents. 

(68) 


REMINISCENCES  OF  THE  PHILADELPHIA  HOSPITAL.  69 

Asa  Frisby  was  a  sober  and  solid  Mississippian,  who  also  was 
a  graduate  of  the  University  of  Pennsylvania  in  1836 ;  he  was 
elected  the  same  year  to  the  hospital  staff;  he  passed  with  us 
through  the  typhus  period,  of  which  both  he  and  Johnson  had 
an  attack,  the  former  severely,  the  latter  lightly ;  and  went  to 
Natchez  at  the  end  of  his  service,  where  he  died  a  few  years  after- 
wards of  yellow  fever. 

John  H.  Fromberger  was  a  graduate  of  the  same  school  in 
1835,  and  became  an  interne  of  Blockley ;  he  settled  in  Delaware, 
was  successful  in  obtaining  a  large  practice,  and  died  in  Florida, 
where  he  had  gone  on  account  of  ill  health. 

Charles  Bell  Gibson,  son  of  professor  William  Gibson  of  the 
University  of  Pennsylvania,  was  graduated  there  in  1836,  and  was 
an  interne  of  Blockley  previous  to  and  after  his  graduation  ;  he 
removed  to  Richmond,  was  elected  professor  in  the  medical  school 
of  that  city,  and  died  at  the  early  age  of  fifty.  Of  the  remaining 
confreres  of  that  company  I  have  but  little  knowledge. 

John  F.  H.  Patterson,  a  graduate  of  the  University  of  1835,  an 
interne  of  Blockley,  a  professor  in  the  medical  college,  died  about 
the  age  of  50 — an  energetic,  earnest,  bright  man. 

Joshua  M.  Wallace,  brother  of  Ellerslie,  a  University  student, 
graduate  of  1836,  a  genial,  whole-souled  fellow,  was  an  interne 
but  for  a  short  time,  when  he  was  transferred  to  the  staff  of  the 
Pennsylvania  Hospital ;  he  died  early  of  pneumonia. 

It  is  unnecessary  to  go  over  the  ground  which  was  brought 
before  us  a  year  ago.  As  usual,  in  the  checkered  scenes  of  life, 
there  were  many  things  which  we  recalled  with  jneasure,  growing- 
out  of  our  intercourse  with  each  other :  others  with  emotions 
arising  from  what  we  considered  a  want  of  appreciation  of  what 
was  due  to  us,  for  no  doubt  the  most  of  the  board  esteemed  us  a 
parcel  of  fellows  of  no  particular  status,  either  in  the  medical  or 
political  world  (and  perhaps  they  were  not  far  from  wrong),  while 
we,  of  course,  thought  ourselves  of  far  more  consequence  than 
the  most  of  them — elected  as  they  were  by  either  the  whig  or  the 
loco-foco  party — and  who,  we  supposed,  cared  more  for  the 
monthly  or  quarterly  dinner  than  anything  else  that  pertained 
to  the  institution.  I  allude  xiow  to  our  sentiments  after  our  elec- 
tion— of  course  previously  we  had  treated  them  with  profound 
respect.  Altogether  we  have  the  confident  conviction  that  we 
there  laid  up  an  amount  of  pathological  and  practical  knowledge 


70  REMINISCENCES  OP  THE  PHILADELPHIA  HOSPITAL. 

which  has  served  as  a  reserve  during  all  the  subsequent  period 
of  our  lives.  While  we  look  back  with  due  appreciation  of 
what  was  gathered  up  at  that  time,  we  are  far  from  acceding  to 
the  sentiment  so  charged,  and  not  always  unjustly,  to  that  frag- 
ment of  our  race  who  have  attained  the  three  score  and  ten  limit, 
"  that  the  old  times  were  better  than  the  present ;  "  nor  yet  do  I 
feel  quite  ready  to  subscribe  to  the  dictum  of  a  medical  friend, 
"that  we  were  born  fifty  years  too  soon."  As  for  the  future,  it  is 
wrapped  up  in  an  impenetrable  scroll ;  and  the  reveries  of  those 
who  assume  to  make  out  the  progress  of  the  coming  century  are 
vain  and  vapid — it  is  enough  for  us  who  can  look  back  for  more 
than  half  a  century  to  ndmire  with  grateful  and  fervent  hearts 
the  wonderful  progress  of  human  ingenuity  and  research  ;  the 
power  of  the  human  mind  in  compelling  the  acknowledgement 
of  the  rights  of  man ;  the  elevation  of  the  down-trodden  at  home 
and  abroad,  and  the  increasing  instability  of  tyrannical  thrones. 

Is  it  possible  that  the  coming  half  century  can  offer  more 
glorious  exhibits  to  the  wondering  minds  of  its  inheritors  than 
the  past  has  shown  to  us  ?  But  we  are  here  as  physicians,  not 
merely  as  citizens  of  this  great  republic,  from  whose  heights,  we 
overlook  not  only  what  is  taking  place  immediately  around  us, 
but  can  take  in  from  most  favorable  positions  the  aspect  of  the 
whole  world  panorama. 

Long  before  the  dawn  of  life  upon  any  of  those  now  present, 
our  profession  experienced  the  slow  advance  made  by  theory  and 
empiricism,  not  only  from  ignoble,  but  also  from  noble  minds  in 
their  earnest  gropings  after  scientific  truth  and  its  application 
to  the  healing  art.  Foremost  among  the  latter  stands  the  "father 
of  medicine,"  whose  name  shines  forth  brightly  amidst  the  dim 
and  obscure  clouds  of  ignorance  and  superstition  which  envel- 
oped the  age  of  Hippocrates.  It  was  a  true  philosophy  which  he 
inculcated ;  a  philosophy  founded  upon  observation  and  induc- 
tion, rather  than  upon  mere  theories ;  but  it  is  not  now  proposed 
to  sjDeak  of  that  age,  that  we  had  over  and  over  again  from  the 
lips  of  our  venerable  professor  in  the  University,  Dr.  John  Red- 
man Coxe.  Having  passed  the  stormy  days  of  1845,  requiescat  in 
pace. 

Let  us  come  far  down  the  stream  of  time  towards  the  present 
century.  We  now.  meet  with  such  men  as  Sydenham,  Cullen, 
Huxham — strong,  original  thinkers,  who  used  all  the  knowledge ' 


REMINISCENCES  OF  THE  PHILADELPHIA  HOSPITAL.  71 

they  gathered  to  the   best  advantage,  and   left  traces,  not   yet 
obliterated,  upon  the  broad  field  of  literature. 

Misty  and  obscure  enough  were  the  notions  even  of  those  upon 
whom  we  still  look  back  with  a  degree  of  reverence  as  being  in 
the  front  rank  of  their  contemporaries.  Doubtless  they  them- 
selves felt  that  great  darkness  surrounded  them,  and  that  their 
vision  penetrated  it  but  feebly;  and  that  it  was  after  all  but 
imperfect  experience  and  worse  theory  which  they  were  obliged 
to  promulgate. 

When  Dr.  Samuel  Jackson  was  asked  why  he  did  not  publish 
another  edition  of  his  work  on  physiology,  a  work  written  in  that 
graceful  and  pleasing  style  which  marked  all  the  productions  of 
his  elegant  mind,  he  replied,  "It  is  sufficient  that  I  state  my  views 
in  my  lectures — they  will  last  as  long  as  they  are  worthy  to  be 
remembered."  "  Don't  tell  me,"  said  John  Hunter,  "  that  my 
teachings  last  year  were  different  from  what  you  have  just  now 
heard — these  are  my  present  opinions."  Such  men  were  true 
philosophers ;  they  were  aware  of  the  imperfection  of  the  deduc- 
tions of  their  day:  and  were  wide  awake  to  scrutinize  every  new 
fact ;  and  even  peered  longingly  into  the  future  for  the  develop- 
ments which  their  minds  but  feebly  anticipated.  Xo  one  per- 
haps of  Dr.  Jackson's  period  felt  more  sensibly  than  he  the  dim- 
ness of  the  light  of  that  period,  or  longed  more  earnestly  for  the 
evolution  of  more  truth  in  medicine  than  he  could  command. 

If  we  would  judge  of  the  men  of  those  days,  we  must,  if  possible, 
come  down  from  our  advanced  position,  and  take  place  among 
the  fogs  and  obscurities  which  surrounded  them ;  and  putting 
on  their  spectacles,  carefully  scan  the  scene  which  would  then 
present  itself.  For  myself,  a  feeling  of  sadness  comes  over  me 
when  I  reflect  upon  the  disadvantages  of  the  true  philosophers  in 
medicine  of  even  half  a  century  ago,  and  doubtless  some  of  us 
will  be  the  subjects  of  the  same  sympathetic  sentiment  by  those 
who  will  live  a  century  hence,  when  many  of  the  works  which 
have  been  built  up  with  so  much  labor  in  our  time,  will  have  had 
written  upon  them  "Tekel." 

But  I  have  said  that  it  is  not  a  subject  of  regret  to  some  of  us, 
that  we  are  not  just  now  entering  upon  the  stage  of  life.  We  have 
had  the  satisfaction,  which  the  younger  members  of  our  profession 
can  never  fully  appreciate,  of  watching  the  wonderful  develop- 
ments of  science— we  have  seen  the  rise  of  theories  and  empiri- 
cisms, as  each  in  turn  called  out  its  followers,  "  Ho,  here's  the 


72  REMINISCENCES  OF  THE  PHILADELPHIA  HOSPITAL. 

throne  of  truth ! "  We  have  seen  the  light  of  these  false  pro- 
phets, which  was  but  little  better  than  darkness,  melt  away 
into  its  own  proper  realm  of  utter  obscurity  ;  while  we  have  also 
observed  the  chariot  of  truth  slowly  advancing,  dimmed  at  times 
by  the  clouds  of  error,  but  again  and  again  coming  into  brighter 
vision,  as  around  it  glowed  the  true  light  of  scientific  research. 

We  need  but  to  revert  to  the  student  days  of  some  of  us,  and 
consider  what  were  the  teachings  and  the  notions  regarding  fevers 
which  were  advanced  from  the  rostrum,  where  stood  the  fine  form 
of  Chapman,  setting  forth  in  beautiful  style  and  language  the 
varieties,  causes,  treatment,  etc.,  of  these  diseases.  In  nothing  was 
both  teacher  and  student  more  perplexed  than  in  these  forms  of 
disease.  If  you  look  into  the  treatises  of  those  days,  you  will 
perceive  how  difficult  it  was  to  arrive  at  a  diagnosis  at  all  satis- 
factory. They  brought  before  the  reader  all  the  theories  from  the 
days  of  Hippocrates  down  to  their  own  times,  and  discussed  them 
laboriously,  and  when  they  had  arrived  at  the  end  of  their  travail, 
they  brought  forth  only  another  theory. 

Chapman  divided  his  fevers  into  intermittent,  remittent  or  bil- 
ious, and  continued,  which  included  synocha,  synochus,  and 
typhus.  In  Dr.  Christison's  arrangement  we  have  primary  fevers, 
synocha,  synochus,  mixed  or  nervous  fever,  and  typhus  or  ady- 
namic, and  continued  and  intermittent.  Is  it  surprising  that  the 
student  should  have  been  puzzled  to  vexation  by  an  arrangement 
which  afforded  no  standing  point,  nor  any  definite  boundary  at 
the  ending,  for,  says  Dr.  Chapman,  "  as  synocha  passes  by  insen- 
sible shades  into  synochus,  so  the  latter  passes  insensibly  into 
typhus."  With  such  a  spectre  as  that  before  him,  what  wonder 
if  the  student  should  have  been  as  much  confounded  as  was 
Hamlet  upon  the  appearance  of  the  ghost  of  his  father. 

The  treatment  was  always  hampered  by  the  idea  of  inflamma- 
tion, no  belief  being  entertained  that  such  temperatures  could 
exist  without  that  basis,  and  as  inflammation  required  depletion, 
emetics,  venesection  and  purgatives  were  of  course  necessary. 
By  various  practitioners  bleeding  was  resorted  to  in  various  degrees, 
from  one  to  six  pounds  of  blood  at  a  dash.  This  was  proposed  as 
Dr.  Chapman  says,  by  Dr.  Jackson,  in  his  practice  of  medicine. 
I  presume  he  means  Dr.  Jackson  of  Boston,  as  I  am  not  aware 
that  Dr.  Samuel  Jackson  of  Philadelphia,  ever  published  a  work 
on  practice.     All  this  was  done  under  the  impression  that  these 


REMINISCENCES  OF  THE  PHILADELPHIA  HOSPITAL.  73 

continued  fevers,  as  they  were  then  called,  could  be  arrested. 
Says  Dr.  Chapman  again  in  glowing  language,  "  Could  I  for  a 
moment  believe  in  the  doctrine  of  our  incompetency  to  cure 
fever — that  all  our  efforts  to  arrest  its  progress  are  unavailing, 
that  we  must  remain  inactive  and  patiently  watch  the  operation 
of  the  vis  medicatrix  naturae  till  the  disease  spontaneously  sub- 
sides, I  would  at  once  strike  the  flag  of  the  profession,  and  cease 
to  cheat  the  public  by  pursuing  any  longer  a  system  of  fraud  and 
imposture."  It  would  seem  that  with  our  present  views  of  the 
self-limitation  of  typhoid  and  typhus  fevers,  we  should  be  as  honest 
as  Dr.  Chapman  asserts  himself  to  have  been ;  but  there  is  no 
necessity  for  that,  enough  remains  to  be  done,  even  with  as  much 
empirical  treatment  as  yet  remains  with  us,  to  conduct  a  case  of 
typhoid  fever  through  its  slow  and  tortuous  course,  even  though 
we  adopt  the  wise  course  "  to  give  nature  a  chance." 

If  we  go  on  a  little  further  we  find  that  typhoid  fever  was 
altogether  unknown  as  a  distinct  disease.  Even  after  the  light 
which  had  been  thrown  upon  it  by  Brettoneau,  Louis  and  Chomel, 
many  of  those  both  in  England  and  in  this  country  who  had 
been  imbued  with  the  old  notions  could  not  bring  themselves  to 
believe  that  typhoid  fever  was  anything  else  than  one  form  of 
continued  or  synochus  fever.  When  we  of  that  day,  in  the  Phil- 
adelphia Hospital,  stood  by  the  bedside  of  our  typhoid  fever 
cases  with  Drs.  Gerhard  and  Pennock,  and  had  pointed  out  to  us 
their  diagnostic  symptoms;  and  had  disease  in  the  glands  of 
Peyer  verified  in  the  autopsy ;  and  when  the  petechial  typhus 
came  among  us  from  the  ships  from  Ireland  and  from  Phila- 
delphia's summer  streets,  and  we  had  shown  to  us  the  differences 
and  the  differential  diagnosis  of  these  two  diseases,  with  the  con- 
fident assurance  that,  in  the  typhus  cases,  we  should  find  no  disease 
in  these  glands,  a  new  and  clear  light  dawned  upon  us  as  to  the 
specific  and  distinct  character  of  the  two  affections.  At  once 
was  dissipated  the  obscurities  which  had  hung  around  us  in 
regard  to  these  fevers,  and  each  stood  out  before  us — individual- 
ized. No  argument  or  description  could  so  effectually  have  con- 
vinced us  of  the  truth  of  the  diagnosis,  as  did  such  demonstra- 
tions from  the  book  of  nature. 

I  think  that  I  am  not  mistaken,  and,  if  I  am,  can  be  corrected 
by  my  friend  Dr.  Stille,  that  Dr.  Samuel  Jackson  and  Dr.  Law- 
rence were  the  first  in  this  country  to  describe  the  ulcerations  in 


74  REMINISCENCES  OP  THE  PHILADELPHIA  HOSPITAL. 

the  intestines,  which. they  found  in  their  patients  who  had  died 
of  an  epidemic  fever  which  prevailed  along  the  Schuylkill  about 
the  year  1824  ;  hut  they  could  go  no  further  than  to  describe 
what  they  had  seen,  without,  however,  arriving  at  any  conclusion 
as  to  the  meaning  of  the  pathological  appearances.  I  may  state 
that  Dr.  Jackson  frequently  expressed  his  regret  that  the  record 
of  the  autopsies  made  by  Dr.  Lawrence  had  been  irrecoverably 
lost.  Dr.  Lawrence  fell  an  early  victim  to  his  devotion  to  patho- 
logy. 

These  certainly  were  very  important  steps ;  but  having  gone 
thus  far  we  are  met  by  the  recent  microscopic  investigations  into 
the  causation  of  disease,  not  only  of  those  fevers  of  which  we 
have  been  speaking,  but  of  various  other  zymotic  diseases,  and 
have  before  us  new  fields  opening  which  promise  to  yield  rich 
fruit,  both  in  pathology  and  therapeutics.  Here,  indeed,  we  are 
amazed  not  only  at  the  scientific  problems  which  seem  to  be  in 
course  of  solution,  but  also  at  the  anticipation  of  practical  results 
which,  if  realized,  will  throw  idto  the  shade  all  that  has  been 
heretofore  accomplished. 

If  I  might  be  permitted  to  go  a  little  further  in  an  exposition 
of  the  difficulties  which  surrounded  those  who  immediately  pre- 
ceded us,  I  woulu  cite  those  connected  with  diseases  of  the  chest. 
Dr.  Chapman,  whose  acquaintance  with  the  literature  of  the  pro- 
fession will  hardly  be  challenged,  had  come  to  the  conclusion 
that  pneumonia  and  pleurisy  were  the  same  disease,  requiring 
about  the  same  treatment.  He  remarks  :  "  of  all  the  diseases  to 
which  the  human  frame  is  liable,  with  the  exception  of  cynanche 
trachealis,  this  is  perhaps  the  best  understood  and  most  easily 
managed."  If  that  were  true  at  that  time,  our  knowledge  in 
respect  to  this  disease  has  woefully  degenerated.  Our  diagnosis 
we  insist  is  incomparably  superior  to  his,  for  we  can  look,  as  it 
were,  into  the  lungs  and  pleura,  and  define  precisely  their  condi- 
tion, but  we  cannot  adopt  his  words.  His  heroic  treatment  by 
profuse  and  repeated  bleedings  we  utterly  discard,  while  at  the 
same  time  it  may  be  fairly  doubted  whether  in  all  cases  vene- 
section is  an  improper  measure,  even  admitting  the  ordinary 
tendency  of  pneumonia  to  terminate  by  crisis  or  lysis.  It  is  easy 
to  understand  how  superior  our  diagnosis  is  by  the  use  of  auscul- 
tation and  percussion,  to  which  the  ear  of  the  world  was  deaf 


REMINISCENCES  OF  THE  PHILADELPHIA  HOSPITAL.  75 

until  Laennec  explained  the  language  of  thoracic  sounds.  While 
great  advances  have  been  made  in  medicine,  we  are  yet  upon 
the  threshold  of  investigation  and  discovery. 

We  have  appliances  in  the  microscope  and  the  laboratory  for 
assisting  us  in  questioning  the  anatomical  and  pathological  struc- 
tures of  the  human  system,  of  which  our  predecessors  knew 
nothing.  As  has  been  remarked,  we  have  seen  the  gradual 
development  of  experiment  and  observation  in  this  direction, 
and  have  admired  the  persistent  devotion  and  enthusiasm  with 
which  observations  have  been  conducted,  which  have  added 
honor  to  human  intellect ;  and  we  have  rejoiced  in  the  prospect 
of  seeing  still  further  developments  of  science  and  of  practical 
results.  Whatsoever  cavil  may  have  been  made  in  former  times 
as  to  the  propriety  of  the  use  of  the  term  "  medical  science,"  there 
ought  to  be  none  now,  if  careful  and  extensive  investigation  and 
wise  generalization  contribute  toward  such  a  claim. 

We  have  seen  the  system  of  auscultation  unfolded  by  the  genius 
of  Laennec,  brought  to  such  a  degree  of  perfection  that  the 
recesses  of  the  bony  thorax  are  laid  open  even  more  satisfactorily 
than  the  contents  of  the  abdomen,  although  the  latter  seems  so 
much  more  accessible.  Both  heart  and  lungs  speak  to  us  of  their 
pathology  in  a  language  which  is  as  intelligible  to  the  initiated 
as  is  French  and  German;  but  only  intelligible  when  carefully 
studied  as  a  language. 

Then  we  are  indebted  to  Dr.  Bright  for  evolving  the  secrets  of 
the  kidneys,  and  we  have  learned  something  of  the  extensive 
influence  which  those  organs  exercise  over  the  operations  of  the 
human  organism.  Still  further,  we  have  watched  the  wonderful 
advances  in  gynaecology  (which  can  be  appreciated  only  by  those 
who  had  merely  such  light  as  from  the  lectures  of  Dewees,  which 
was  almost  darkness) ;  we  have  also  learned  much  of  the  power 
of  the  uterus  and  ovaries  over  the  nervous  system ;  and  have  had 
placed  in  our  hands  such  means  and  appliances  as  have  enabled 
us  to  bring  health  and  comfort  to  women,  instead  of  the  sadness 
and  sorrow  which  they  hopelessly  endured  for  so  many  centuries 
— a  relief  which  is  only  second  to  the  moral  and  social  elevation 
brought  about  by  the  divine  agency  of  Christianity  in  raising  her 
out  of  a  woful  degradation  into  the  full  dignity  and  honor  of 
man. 


76  REMINISCENCES  OP  THE  PHILADELPHIA  HOSPITAL. 

Last,  but  not  least,  we  see  the  efforts  now  being  made  to  demon- 
strate that  of  the  great  causes  of  the  mortality  of  the  human  race, 
the  greatest  is  the  want  of  .pure  air,  pure  water,  and  physical  clean- 
liness, all  of  which  we  know  have  laid  the  foundations  for  disease 
and  death,  whereas  before  we  could  only  imagine  some  latent  and 
undiscoverable  energy  at  the  bottom  of  the  whole  trouble. 


HISTORICAL   MEMORANDA    OF   THE   PHILADELPHIA 

ALMSHOUSE. 


By  CHARLES  K.  MILLS,  M.D. 


The  most  important  medical  facts  relating  to  the  period  which 
his  essay  covers  are  given  by  Dr.  Agnew,  but  to  many  events  of 
interest  he  simply  alludes,  and  to  some  of  the  details  connected 
with  the  history  of  the  almshouse  system  in  Philadelphia,  which 
are  in  a  broad  sense  part  of  its  medical  history,  he  does  not  refer. 
In  the  following  pages,  therefore,  some  of  the  facts  given  will  be 
in  the  nature  of  addenda  to  his  history  of  the  hospital.  Some  of 
the  documents  relating  to  the  almshouse  are  of  importance  to 
an  exact  knowledge  of  the  history  of  the  institution ;  such,  for 
instance,  are:  the  act  of  1828,  for  the  erection  of  a  new  almshouse; 
the  original  deed  of  the  property  purchased  by  the  city  in  Block- 
ley  township ;  the  act  of  1861  for  the  sale  of  the  almshouse  grounds 
or  any  parts  thereof;  and  the  ordinance  of  councils  of  1883  setting- 
aside  a  portion  of  the  almshouse  property  for  a  public  park.  We 
have,  therefore,  at  the  expense  of  space,  considered  it  worth  while 
to  give  these  documents,  or  large  extracts  from  them.  The  his- 
tory of .  the  Philadelphia  Hospital,  with  which  this  volume  is 
particularly  concerned,  is  so  intermingled  with  that  of  the  alms- 
house system  in  general,  and  with  numerous  official  acts  for  the 
relief  of  the  poor,  that  a  knowledge  of  these  is  necessary  to  an 
understanding  of  the  hospital  and  its  relations.  Descriptions 
of  the  almshouse  at  its  three  locations  may  prove  of  future  as 
well  as  present  value,  as  may  also  a  consideration  of  the  history 
of  the  various  forms  of  government  of  the  poor  and  of  the  insti- 
tutions concerned  with  their  care  and  treatment. 

Dr.  Agnew  began  his  history  at  1742,  with  the  general  state- 
ment that  the  Philadelphia  Almshouse  was  at  that  time  fulfilling 
a  varied  routine  of  beneficent  functions,  including  hospital  and 

(77) 


78      HISTORICAL  MEMORANDA  OF  THE  PHILADELPHIA  ALMSHOUSE. 

asylum  work.  One  of  the  first  acts  for  the  better  provision  of 
the  poor  in  Pennsylvania  was  passed  in  1700,  and  repealed  by 
the  Queen  in  council  in  1705.  A  year  later  the  assembly  directed 
that  the  justices  of  the  peace  should  annually  appoint  two  over- 
seers of  the  poor  for  each  township ;  and  also  that  a  levy  of  one 
penny  a  pound  should  be  made  upon  all  real  and  personal  estate  of 
citizens,  and  four  shillings  a  head  not  otherwise  ratified. 

In  1712,  the  common  council  ordered  that  a  workhouse  be  hired 
for  the  eniplojmient  of  the  poor,  and  the  overseers  were  empow- 
ered to  attend  to  this  business.  It  is  not  certain  that  these  direc- 
tions were  carried  out.  In  1713,  however,  the  first  almshouse 
was  established,  but  it  was  strictly  confined  to  the  relief  of  the 
poor  of  the  society  of  Friends.  In  1717,  the  assembly  passed  an 
act  authorizing  the  erection  of  a  workhouse  in  Philadelphia, 
Chester  and  Bristol. 

In  1729,  in  answer  to  a  petition  made  to  the  assembly  by  the 
overseers  of  the  poor  and  recommended  by  the  city,  one  thousand 
pounds  were  loaned  to  the  mayor  and  commonwealth  for  the 
purchase  of  ground  and  the  erection  of  a  building  for  the  poor 
of  the  city.  This  money  was  received  in  1720,  and  in  1721  or 
1722,  ground  was  bought  from  Aldran  Allen  for  two  hundred 
pounds ;  this  was  bounded  by  Third,  Fourth,  Spruce  and  Pine 
streets,  referred  to  by  Dr.  Agnew  as  the  "  green  meadows."  The 
building  was  of  brick  and  probably  completed' in  1731  or  1732. 
In  it,  besides  an  asylum  for  paupers,  was  established  a  hospital 
with  accommodations  for  the  sick  and  insane.  From  1732  we 
can,  therefore,  properly  date  the  history  of  the  Philadelphia 
Hospital. 

The  immense  growth  of  this  hospital  is  well  shown  by  refer- 
ence to  two  facts.  In  1767,  according  to  Scharf  and  Westcott, 
284  persons  were  admitted  into  the  almshouse,  and  afterwards 
the  number  increased  to  368.  December  31,  1889,  by  the  report 
of  Mr.  Robert  Laughlin,  president  of  the  board  of  charities 
and  correction,  the  entire  population  of  the  almshouse,  includ- 
ing the  hospital,  insane  department,  men's  and  women's  out- 
wards, and  the  children's  asylum,  was  3,207.  In  1888,  according 
to  the  report  of  the  chief  druggist,  110,875  prescriptions  were 
filled,  a  number,  as  remarked  by  Dr.  J.  W.  White,  then  president 
of  the  board,  probably  greater  than  the  business  of  any  ten  of 
the  largest  drug  stores  in  the  city.      In  1889,  the  number   of 


HISTORICAL  MEMORANDA  OF  THE  PHILADELPHIA  ALMSHOUSE.      79 

prescriptions  compounded  was  101,539.  Large  as  is  this  appa- 
rent increase,  however,  it  is  not  great  in  proportion  to  the  increase 
in  the  population  of  the  city. 


BIBLIOGRAPHY  AND  LITERATURE  OF  THE  PHILADELPHIA  HOSPITAL. 

With  the  exception  of  the  medical  history  of  Dr.  Agnew  no 
extended  account  of  the  Philadelphia  Almshouse  has  been  pub- 
lished ;  but  facts  with  reference  to  it  may  be  found  in  various 
volumes  which  deal  with  the  local,  medical,  legal  and  official  his- 
tory of  Philadelphia.  We  will  give  here  a  list  of  works,  and  a 
statement  of  some  sources  of  information,  which  have  proved  of 
advantage  to  us  and  may  to  others. 

Lectuee  ox  the  Medical  History  of  the  Philadelphia  Almshouse. 
Delivered  at  the  opening  of  the  Clinical  Lectures,  October  15,  1862.  By  D.  Hayes 
Agnew,  M.D.  Philadelphia:  Holland  &  Edgar,  printers,  54  North  Eighth  street, 
1862. 

A  History  of  the  Medical  Departmext  of  the  Uxiveesity  of  Pexx- 
SYLVAXIA.  By  Joseph  Carson,  M.  D.  Philadelphia  :  Lindsay  &  Blakiston, 
1889.  In  this  well-knoAvn  work  of  Dr.  Carson  the  references  to  the  Philadel- 
phia Hospital  are  taken  chiefly  from  Dr.  Agnew's  pamphlet,  but  a  few  additional 
facts  of  interest  are  mentioned. 

Ixteodlctoey  Lecture  to  the  Clixical  Course  of  the  Philadelphia 
Hospital  foe  the  Wixter  of  1855-56.  By  Robert  K.  Smith,  M.D.  Published 
in  pamphlet  form.     Philadelphia,  1855. 

Summee  Medical  Teachixg  ix  Philadelphia.  An  introductory  lecture, 
delivered  before  his  class  in  pharmacy,  April  13,  1857.     By  Edward  Parrish,  M.D. 

The  Pictuee  of  Philadelphia.  Giving  an  account  of  its  origin,  increase, 
improvement,  etc.  With  a  compendium  of  the  societies,  police,  institutions,  etc. 
By  James  Mease.     Philadelphia,  1811. 

Picture  of  Philadelphia.  Or  a  brief  account  of  the  various  institutions 
and  public  objects  in  this  metropolis.  Being  a  guide  for  strangers.  With  addenda 
of  all  the  improvements  to  the  present  time.     E.  L.  Cary  and  A.  Hart,  1835. 

Axxals  of  Philadelphia  and  Pesxsylyaxia  ix  the  Oldex  Time.  In 
two  volumes.     By  John  F.  Watson.     Philadelphia,  185T. 

Histoey  of  Philadelphia.  1609  to  1884.  In  three  volumes.  By#J.  Thomas 
Scharf  and  Thompson  Westcott.     Philadelphia.  1884. 

A  History  of  Municipal  Developmext.  Philadelphia,  1681-1887.  By 
Edward  P.  Allison  and  Boies  Penrose.     Baltimore  and  Philadelphia,  1887. 

In  the  Philadelphia  Library  are  eight  volumes  of  Poulsox's  Newspaper 
Cuttixgs,  search  of  which  will  reveal  some  notes  relating  to  the  almshouse  and 
hospital. 

Rev.  C.  F.  Pearson,  who,  ripe  in  years  and  good  works,  is  still  connected  with  the 
almshouse,  published  a  volume  in  1875,  religious  in  tone,  entitled,  Sparks 
among  the  Ashes.    Including  reminiscences  of  nineteen  years  of  labor  in  the 


80      HISTORICAL  MEMORANDA  OF  THE  PHILADELPHIA  ALMSHOUSE. 

Philadelphia  Almshouse.  With  an  introduction  by  Mrs.  Dr.  Bell.  Some  inter- 
esting reminiscences  of  Blockley  characters  are  to  he  found  in  this  volume. 

Among  other  sources  of  information  are  the  published  Annual  Statements  or 
Eeports  of  the  board  of  guardians  of  the  poor,  and  since  1887  the  Annual  Reports 
of  the  department  of  charities  and  correction.  Bound  volumes,  from  1844  to  1854, 
are  to  be  found  in  the  Philadelphia  library  ;  and  in  the  library  of  the  Philadelphia 
Hospital  from  1853  to  1883,  the  latter  presented  by  a  former  president  of  the  board 
of  guardians,  Mr.  Edward  F.  Hoffman  ;  also  several  bound  volumes  are  to  be  found 
at  the  office  of  the  bureau  of  correction,  Harmony  and  Hudson  streets. 

At  various  periods,  rules  for  the  government  of  the  board  of  guardians,  of  the  medi- 
cal board,  and  of  the  department  of  charities  and  correction  have  been  published,  and 
afford  much  information.  Among  these  are  the  following  :  Eules  for  the  Govern- 
ment of  the  Board  of  Guardians,  1828  ;  Laws  for  the  Relief  and  Employment  of 
the  Poor,  1844  ;  Rules  for  the  Guardians  of  the  Poor,  1861  ;  Rules  for  the  Guar- 
dians of  the  Poor,  1868  ;  Rules  for  the  Medical  Board,  1870  ;  Rules  for  the  Depart- 
ment of  Charities  and  Correction,  1890. 

In  the  preparation  of  historical  notes  and  memoranda  we  have  made  use  of  these 
and  also  of  the  written  minutes  of  the  board  of  guardians  of  the  poor,  and  of  the 
bureau  of  charities,  which,  with  much  other  material,  have  been  placed  at  our 
disposal  through  the  kindness  of  Mr.  Robert  Laughlin.  To  Mr.  Robert  C.  Floyd, 
secretary  of  the  bureau  of  charities,  and  to  Mr.  Edwin  Palmer,  secretary  of  the 
bureau  of  correction,  we  are  under  obligations  for  valuable  information  and  docu- 
ments. We  have  also  consulted  the  written  minutes  of  the  medical  board  of  the 
Philadelphia  Hospital,  which  have  been  placed  in  our  hands  by  the  secretary,  Dr. 
Louis  W.  Steinbach.  At  the  almshouse  are  documents,  minute  books,  records,  etc., 
to  which  we  have  had  access  through  the  courtesy  of  Mr.  George  Roney,  the  super- 
intendent, to  whom  great  credit  is  due  for  the  manner  in  which  he  has  collated 
and  arranged  these  archives  of  the  almshouse,  formerly  in  extreme  confusion. 

This  is  an  appropriate  place  to  say  a  word  about  the  literature  of 
the  Philadelphia  Hospital,  or  rather  about  the  contributions  of  the 
members  of  its  various  medical  boards  to  the  literature  of  the 
profession.  These  constitute  a  large  portion  of  the  literature  of 
Philadelphia  medicine.  It  would  be  an  interesting  task  to  col- 
lect the  contributions  which  owe  their  existence  to  work  clone 
within  the  walls  of  the  Philadelphia  Hospital.  In  the  notes 
on  the  epidemics  of  the  hospital,  references  are  made  to  a 
few  valuable  contributions ;  as  to  the  monograph  on  epidemic 
meningitis,  by  Dr.  Alfred  Stille,  to  the  paj)er  on  the  same  subject 
by  Dr.  W.  H.  H.  Githens ;  and  to  that  on  puerperal  septicaemia  as 
observed  at  the  hospital,  by  Dr.  W.  H.  Parish.  On  pathology  the 
hospital  has  furnished  contributions  without  number,  and  some 
of  great  value,  particularly  during  the  last  fifteen  years.  The 
medical  societies  of  Philadelphia — the  college  of  physicians,  the 


' 


HISTORICAL  MEMORANDA  OF  THE  PHILADELPHIA  ALMSHOUSE.      81 

county  medical,  the  pathological,  obstetrical,  neurological  society, 
etc. — have  drawn  largely  from  this  hospital  for  their  material,  as 
a  search  of  their  transactions  will  at  once  make  evident.  The 
record  of  the  pathological  society  of  Philadelphia,  as  indicated 
in  its  volumes  of  transactions,  would  be  meagre  indeed,  if  the 
material  supplied  by  the  Philadelphia  Hospital  were  omitted. 


EARLY  HOSPITALS  AND  ALMSHOUSES  OF  PHILADELPHIA. 

From  Watson's  Annals,  Scharf  and  Westcott's  History  of  Phila- 
delphia, Allison  and  Penrose's  History  of  Municipal  Develop- 
ment, and  other  sources,  we  will  give  a  few  notes  and  citations 
with  reference  to  the  hospitals  and  almshouses  of  early  Philadel- 
phia, and  the  methods  of  caring  for  the  poor,  both  well  and  sick, 
to  assist  by  comparison,  to  a  better  knowledge  of  the  position, 
history  and  work  of  the  great  institution  with  which  we  are  par- 
ticularly concerned  in  these  pages. 

While  the  Philadelphia  Hospital  is  the  oldest  in  the  city,  the  Pennsylvania  Hos- 
pital was  the  first  separate  institution  of  this  kind,  that  is,  the  first  distinct  from 
an  almshouse  or  other  institution.  In  1751,  Dr.  Thomas  Bond  projected  a  plan  for 
a  general  hospital  for  Philadelphia,  and  obtained  the  support  of  Franklin  ;  and  this 
was  the  origin  of  the  Pennsylvania  Hospital.  A  charter  was  granted  in  May,  1751, 
and  the  first  trustees  were  elected  in  the  July  following.  Judge  Kinsey's  house 
on  the  south  side  of  Market  street  (then  called  High  street),  above  Fifth,  was  rented, 
refitted  for  the  reception  of  patients,  and  opened  in  1752.  In  1754,  the  managers 
bought  the  ground  upon  which  the  hospital  still  stands,  between  Spruce  and  Pine 
and  Eighth  and  Ninth  streets,  and  the  corner-stone  of  the  first  building  here  was 
laid  May  28,  1755. 

The  Friends'  Almshouse  of  Philadelphia,  which  ante-dated  by 
a  number  of  years  the  first  institution  of  the  kind  under  the 
municipality,  is  described  by  Scharf  and  Westcott. 

"In  1713  the  first  almshouse  was  established.  It  was  determined  by  the  city 
council  in  July,  1712,  that,  as  the  poor  of  the  city  were  daily  increasing,  a  work- 
house should  be  founded  for  employing  the  poor  ;  the  overseers  to  hire  the  house, 
and  the  council  to  determine  the  rent  and  pay  of  superintendence.  The  mayor, 
aldermen  Hill  and  Carter,  and  councilmen  Carpenter,  Hudson  and  Teague,  were 
appointed  to  take  the  matter  in  charge.  In  the  meantime,  however,  before  the 
councils  acted  finally,  the  Friends  had  founded  their  own  almshouse.  It  was 
established  in  a  small  house  on  the  south  side  of  Walnut  street,  between  Third  and 
Fourth  streets,  where,  in  1729,  the  ancient,  well-known  building,  called  the 
Friends'  Almshouse,  was  built,  to  stand  till  1841.     The  lot  belonged  to   John 

6 


82      HISTORICAL  MEMORANDA  OF  THE  PHILADELPHIA  ALMSHOUSE. 

Martin  and  contained  a  small  tenement. .  Martin  was  poor,  and  gave  his  property 
to  the  society  of  friends  upon  condition  that  they  would  take  care  of  him  for  the 
remainder  of  his  days.  A  cluster  of  small  houses  was  huilt  to  John  Martin's  tene- 
ment, and  this  was  the  Friends'  Almshouse.  In  1729,  a  front  range  of  buildings 
was  put  up  connecting  with  the  previous  structures.  It  was  a  quaint  pile  with  an 
arched  entrance,  and  all  about  the  buildings  looked  antique  and  primitive.  The 
Friends'  Almshouse,  at  first  in  general  public  use,  soon  became  a  private  retreat 
for  indigent  persons  of  the  Quaker  faith.  Each  family  was  separately  lodged,  and 
if  any  had  a  trade  or  calling,  he  was  expected  to  do  what  he  could  at  it  and  so 
lessen  the  burthen  of  his  expense  to  the  society." 

Watson  describes  the  first  almshouse  under  city  control : 

' '  The  original  poor-house  for  the  city  Avas  located  down  town  on  a  green  meadow, 
extending  frorn  Spruce  to  Pine  streets,  and  from  Third  to  Fourth  streets.  Its  .front 
was  to  the  east  and  nearest  to  Third  street.  Its  great  gate  was  on  Spruce  street, 
aud  its  entrance  on  Third  street  was  by  a  stile.  The  house  was  much  such  a  struct- 
ure as  to  height  and  general  appearance  as  that  of  the  Friend's  Almshouse  in  Wal- 
nut street ;  it  had  a  piazza  all  round.  It  contained  the  sick  and  insane  as  well  as 
the  poor.  There  were  also  some  parts  of  the  necessary  buildings  formed  near  the 
corner  of  Union  and  Fourth  streets,  on  the  site  now  occupied  by  Dr.  Physick,  from 
which  cause,  I  find,  in  1758,  it  was  called  '  the  almshouse  down  Fourth  street, '  and 
'the  almshouse  square.'     It  was  completed,  as  already  stated,  in  1731  or  1732." 

"At  and  before  the  year  1740,"  says  Watson,  "it  was  the  practice  when  sick  emi- 
grants arrived  to  jfiace  them  in  empty  houses  about  the  city.  Sometimes  diseases 
were  imparted  in  the  neighborhood,  as  once  occurred,  particularly  at  Willing's 
alley.  On  such  occasions  physicians  were  provided  for  them  at  public  expense. 
The  governor  was  induced,  in  1741,  to  suggest  the  securing  of  a  pest-house  or  hos- 
pital ;  and  in  1742  a  pest-house  was  erected  on  Fisher's  Island,  called  afterwards 
Province  Island,  because  purchased  and  owned  by  the  province  for  the  use  of  sick 
persons  arriving  from  sea." 

The  same  authority  has  an  interesting  note  with  reference  to 
hospitals  for  soldiers  during  the  Revolution  : 

"  In  the  time  of  .the  war,  as  has  been  told  under  its  appropriate  head,  they  made 
use  of  several  empty  private  houses  for  the  reception  of  the  sick  soldiery  by  the 
camp  fever.  The  house  of  the  present  Schuylkill  bank,  at  the  southeast  corner  of 
Sixth  and  High  streets,  then  deserted  by  the  tory  owner,  lawyer  GalloAvay,  was 
filled  with  these  feeble  men  of  war.  At  the  same  time,  the  large  building  in 
Chestnut  street  (late  judge  Tilghman's)  was  also  so  used." 

The  following  is  the  description  by  Scharf  and  Westcott  of  the 
second  city  almshouse  opened  in  1767  on  the  Society  Grounds, 
between  Spruce  and  Pine,  and  Tenth  and  Eleventh  streets  : 

' '  The  buildings  were  opened  in  October,  1767.  The  almshouse  was  laid  out  in 
the  form  of  an  L,  180  feet  by  40,  two  stories  in  height,  joined  by  a  turret  30 
feet  square  and  four  stories  high.  The  honse  of  employment  wras  on  the  west  side 
of  the  lot  running  south  from  Spruce,  fronting  Eleventh  street,  also  in  the  shape  of 


. 


HISTORICAL  MEMORANDA  OF  THE  PHILADELPHIA  ALMSHOUSE.      83 

an  L,  so  that  the  entire  range  of  buildings  inclosed  on  three  sides  a  quadrangular 
space.  A  large  central  building  was  erected  on  Spruce  street,  which  stood  between 
the  L's.  The  first  story  of  the  almshouse  and  house  of  employment  on  the  interior 
was  a  cloister  of  open  arches.  The  buildings  on  Tenth  and  Eleventh  streets  occu- 
pied two  stories  and  a  garret.  The  main  central  building  when  finished  was  three 
stories  in  height,  with  a  hip-roof,  surmounted  by  a  small  cupola. ' ' 

Evidently  the  central  building  was  erected  some  time  after  the  others,  as  in 
Watson's  Annals,  Vol.  Ill,  page  332,  is  a  picture  of  this  almshouse  without  the 
central  building.  Dr.  Agnew  locates  the  institution  of  this  date  wrongly  between 
Eleventh  and  Twelfth  instead  of  between  Tenth  and  Eleventh  streets. 

Scharf  and  Westcott  also  describe  the  Block  ley  buildings  first 
occupied  in  1834 : 

"  Upon  this  lot  were  erected  four  distinct  buildings  disposed  at  right  angles  with 
each  other,  and  enclosing  an  interior  space  of  seven  hundred  by  five  hundred  feet. 
The  men's  almshouse  fronted  the  southeast.  The  main  building  contained  a  por- 
tico ninety  feet  front,  supported  by  eight  columns,  in  the  Tuscan  order,  built  of 
brick,  and  roughcast,  and  was  flanked  by  two  wings,  each  two  hundred  feet  in 
length.  The  portico  being  elevated  on  a  high  flight  of  steps,  rising  beyond  the 
basement  story  to  those  of  the  principal  story,  gave  to  this  group  of  buildings  a 
commanding  appearance.  The  women's  almshouse  was  directly  opposite  the 
department  for  males,  on  the  northwest  side  of  the  quadrangle.  Between  these 
buildings,  on  the  sides,  was  the  hospital,  five  hundred  feet  front,  and  the  house  of 
employment,  of  the  same  dimensions,  immediately  opposite.  Court  yards  and 
yards  of  labor,  gardens  and  walks,  were  allotted  to  each  building  for  the  accommo- 
dation of  the  inmates,  the  departments  being  separated  by  walls.  In  time,  how- 
ever, the  inclosure  became  filled  up  with  buildings  absolutely  necessary  for  the  use 
of  the  establishment.  The  group  of  buildings  was  considered  sufficient  to  accom- 
modate four  thousand  persons,  and  the  cost  was  about  §900,000." 

Later  we  will  give  a  description  of  the  present  almshouse 
and  hospital  buildings  and  grounds,  the  main  structures 
being  practically  the  same  as  when  they  were  erected  between 
1830  and  1834.  We  will  also  describe  the  position  and  arrange- 
ment of  the  different  departments,  offices,  quarters,  etc. 


"EVANGELINE"  AND  THE  PHILADELPHIA  ALMSHOUSE. 

The  old  Philadelphia  Almshouse  and  its  hospital  wards  have 
not  escaped  the  gentle  attentions  of  the  poet.  The  readers  of 
Longfellow  will  remember  the  pathetic  ending  of  the  story  of 
Evangeline;  how  in  the  wards  of  the  old  almshouse  hospital  in  the 
time  of  one  of  the  terrible  plagues,  so  eloquently  referred  to  by  Dr. 
Agnew,  after  years  of  troublous  wandering,  the  two  lovers,  now 
grown  old  in  years  and  suffering,  again  met  for  a  few  brief  hours 


84      HISTORICAL  MEMORANDA  OF  THE  PHILADELPHIA  ALMSHOUSE. 

before  death  parted  them  forever.  Evangeline,  who  had  become 
a  sister  of  mercy,  recognizes  her  old  lover  Gabriel  in  one  of  the 
fever  stricken  patients.  As  it  was  in  1755,  that  the  French  Aca- 
dians  of  Grand  Pre,  nineteen  hundred  peaceful,  happy  souls  were 
dispossessed  of  their  homes,  and  began  their  wanderings,  the 
event  idealized  by  the  poet  can  probably  be  referred  to  the  epi- 
demic of  yellow  fever  in  1793,  and  to  the  almshouse  building  at 
Tenth  and  Spruce  streets,  first  occupied  in  1767.  This  incident 
has  been  described  as  occurring  in  the  old  Fourth  and  Spruce 
streets  almshouse,  occupied  from  1732  to  1767;  but  as  Gabriel  and 
Evangeline  had  grown  old  and  gra}r,  the  meeting  evidently  should 
be  located  in  the  institution  on  the  Society  Grounds  between 
Tenth  and  Eleventh  streets. 

"  To  that  delightful  land  which  is  washed  by  the  Delaware's  waters, 

Guarding  in  sylvan  shades  the  name  of  Penu  the  apostle, 

Stands  on  the  hanks  of  its  beautiful  stream  the  city  he  founded. 

There  all  the  air  is  balm,  and  the  peach  is  the  emblem  of  beauty, 

And  the  streets  still  re-echo  the  names  of  the  trees  of  the  forest, 

As  if  they  fain  would  appease  the  Dryads  whose  haunts  they  molested. 

There  from  the  troubled  sea  had  Evangeline  landed,  an  exile, 

Finding  among  the  children  of  Penn  a  home  and  a  country. 

There  old  Rene"  Leblanc  had  died  ;  and  when  he  departed, 

Saw  at  his  side  only  one  of  his  hundred  descendants. 

Something  there  was  at  least  in  the  friendly  streets  of  the  city  ; 

Something  that  spake  to  her  heart  and  made  her  no  longer  a  stranger  ; 

And  her  ear  was  pleased  with  the  Thee  and  Thou  of  the  Quaker, 

For  it  recalled  the  past,  the  old  Acadian  country, 

Where  all  men  are  equal,  and  all  were  brothers  and  sisters. 

The  end  of  the  romance  within  the  walls  of  Blockley  is  thus 
told: 

"Then  it  came  to  pass  that  a  pestilence  fell  on  the  city, 

Presaged  by  wondrous  signs,  and  mostly  by  flocks  of  wild  pigeons, 

Darkening  the  sun  in  their  flight,  with  naught  in  their  craws  but  an  acorn  ; 

And  as  the  tides  of  the  sea  arise  in  the  month  of  September, 

Flooding  from  silver  streams,  till  it  spreads  to  a  lake  in  the  meadows, 

So  death  flooded  life,  and  o'erflowing  its  natural  margin, 

Spread  to  a  brackish  lake,  the  silver  stream  of  existence. 

Wealth  had  no  power  to  bribe,  nor  beauty  to  charm,  the  oppressor  ; 

But  all  perished  alike  beneath  the  scorn  of  his  anger  ; — 

Only,  alas  !  the  poor,  who  had  neither  friends  or  attendants, 

Crept  to  die  in  the  almshouse,  home  of  the  homeless. 

' '  Suddenly  as  if  arrested  by  fear  or  a  feeling  of  wonder, 

Still  she  stood,  with  her  colorless  lips  apart,  while  a  shudder 

Ran  through  her  frame,  and  forgotten  the  flowers  dropped  from  her  fingers, 


HISTORICAL  MEMORANDA  OF  THE  PHILADELPHIA  ALMSHOUSE.       85 

And  from  her  eyes  and  cheeks  the  hloom  of  the  morning. 
Then  there  escaped  from  her  lips  a  cry  of  such  terrible  anguish, 
That  the  dying  heard  it,  and  started  up  from  their  pillows. 
On  the  pallet  before  her  was  stretched  the  form  of  an  old  man. 
Long,  and  thin,  and  gray  were  the  locks  that  shaded  his  temples  ; 
But  as  he  lay  in  the  morning  light,  his  face  for  a  moment 
Seemed  to  assume  once  more  the  forms  of  its  earlier  manhood  ; 
So  are  wont  to  he  changed  the  faces  of  those  who  are  dying. 
Hot  and  red  on  his  lips  still  burned  the  flush  of  fever, 
As  if  life,  like  the  Hebrew,  with  blood  had  besprinkled  its  portals 
That  the  Angel  of  Death  might  see  the  sign,  and  pass  over. 
Motionless,  senseless,  dying  he  lay,  and  his  spirit  exhausted 
Seemed  to  be  sinking  down  through  infinite  depths  in  the  darkness, 
Darkness  of  slumber  and  death,  forever  sinking  and  sinking. 
Then  through  those  realms  of  shade,  in  multiplied  reverberations, 
Heard  he  that  cry  of  pain,  and  through  the  hush  that  succeeded 
Whispered  a  gentle  voice,  in  accents  tender  and  saint-like, 
'  Gabriel !  O  my  beloved  ! '  and  died  away  in  the  silence. ' ' 

******** 

The  Society  Grounds  in  those  days  were  well  in  the  outskirts 
of  the  city,  but  before  the  removal  to  Blockley  the  march  of 
improvement  had  reached  this  location. 

<l  Then  in  the  suburbs  it  stood,  in  the  midst  of  meadows  and  woodland, 
Now  the  city  surrounds  it ;  but  still  with  its  gateway  and  wicket 
Meek,  in  the  midst  of  splendor,  its  humble  walls  seem  to  echo 
Softly  the  words  of  the  Lord  : — "The  poor  always  have  ye  with  you.' 
Thither  by  day  and  night  came  the  Sister  of  Mercy.     The  dying 
Looked  up  into  her  face,  and  thought,  indeed,  to  behold  there 
Gleams  of  celestial  light  encircle  her  forehead  with  splendor, 
Such  as  the  artist  paints  o'er  the  brows  of  saints  and  apostles, 
Or  such  as  hangs  by  night  o'er  a  city  seen  at  a  distance. 
Unto  their  eyes  it  seemed  the  lamps  of  the  city  celestial, 
Into  whose  shining  gates  ere  long  their  spirits  would  enter. 

'!  Thus,  on  a  Sabbath  morn,  through  the  streets,  deserted  and  silent, 
Wending  her  quiet  way,  she  entered  the  door  of  the  almshouse. 
Sweet  on  the  summer  air  was  the  odor  of  flowers  in  the  garden  ; 
She  paused  on  her  way  to  gather  the  fairest  among  them, 
That  the  dying  once  more  might  rejoice  in  their  fragrance  and  beautjT. 
Then  as  she  mounted  the  stairs  to  the  corridors  cooled  by  the  east  wind 
Distant  and  soft  on  her  ear  fell  the  chimes  from  the  belfry  of  Christ  Church, 
While  intermingling  with  these,  across  the  meadows  were  wafted 
Sounds  of  songs  that  were  sung  by  the  Swedes  in  their  church  at  Wicaco. 
Soft  as  descending  wings  fell  the  calm  of  the  hour  on  her  spirit ; 
Something  within  her  said,  'At  length  thy  trials  are  ended  ;' 
And  with  light  in  her  looks  she  entered  the  chambers  of  sickness. 

Vanished  the  vision  away,  but  Evangeline  knelt  by  his  bedside. 
Vainly  he  strove  to  whisper  her  name,  for  the  accents  unuttered 
Died  on  his  lips,  and  their  motion  revealed  what  his  tongue  would  have  spoken, 


86       HISTORICAL  MEMORANDA  OF  THE  PHILADELPHIA  ALMSHOUSE. 

Vainly  he  strove  to  arise  ;  and  Evangeline  kneeling  beside  him, 
Kissed  his  dying  lips  and  laid  his  head  on  her  bosom. 
Sweet  was  the  light  of  her  eyes  ;  but  it  suddenly  sunk  into  darkness, 
As  when  a  lamp  is  blown  out  by  a  gust  of  wind  at  a  casement. 

"All  was  ended  now  ;  the  hope,  the  fear,  and  the  sorrow, 

All  the  aching  of  heart,  the  restless,  unsatisfied  longing, 

All  the  dull,  deep  pain,  and  constant  anguish  of  patience ! 

As  she  pressed  once  more  the  lifeless  head  to  her  bosom, 

Meekly  she  bowed  her  own,  and  murmured,  'Father,  I  thank  thee  ! '  " 


METHODS  OF  CARING  FOR  THE  POOR  AND  SICK  OF  PHILADELPHIA 
FROM  EARLY  TIMES  TO  THE  PRESENT.     FORMS  OF  GOVERN- 
MENT OF  THE  ALMSHOUSE  AND  HOSPITAL. 

We  will  rapidly  summarize  the  history  of  the  different  bodies 
or  boards  which  have  managed  the  city  almshouse,  the  hospital, 
and  other  connected  departments. 

On  February  8, 1766,  the  assembly  passed  an  act  for  the  better  employment,  relief 
and  support  of  the  poor  within  the  city  of  Philadelphia,  district  of  Southwark,  and 
the  townships  of  Moyamensing,  Passyunk  and  the  Northern  Liberties.  By  this 
law,  every  person  who  contributed  ten  pounds  toward  the  almshouse  became  thereby 
a  corporator,  with  power  to  elect  twelve  managers,  a  treasurer,  etc.  This  body  was 
known  as  "  Contributors  to  the  Relief  and  Employment  of  the  Poor  within  the  city 
of  Philadelphia."  The  contributors  were  authorized  to  erect  a  commodious  build- 
ing, and  the  managers  purchased  a  lot  of  ground  bounded  by  Spruce  and  Pine, 
Tenth  and  Eleventh  streets,  for  eight  hundred  pounds,  and  the  buildings  located 
on  this  ground  were  opened  to  the  public,  as  already  stated,  in  October,  1767. 

During  the  revolution  the  "Contributors"  were  impoverished  and  their  mem- 
bership reduced,  and  a  law  was  passed  in  1781  investing  the  overseers  of  the  poor 
with  all  the  powers  of  a  corporation  under  the  title  of  ' '  Guardians  of  the  Poor  of 
the  City  of  Philadelphia."  In  1803,  the  assembly  ordered  that  the  guardians 
should  be  elected  annually,  sixteen  by  the  corporation  of  this  city,  six  by 
Southwark  corporation,  eight  by  the  justices  of  the  peace  of  the  township  of  the 
Northern  Liberties.  Outside  of  these  limits  the  poor  were  attended  by  their  own 
overseers.  By  an  act  passed  March  5,  1828,  the  number  of  guardians  from  South- 
wark and  the  Penn  townships  were  reduced  to  twelve. 

This  plan  for  the  appointment  of  the  guardians  of  the  poor,  or  one  similar  to  it, 
remained  down  to  the  time  of  the  consolidation  of  the  county  into  the  city  in  1854. 
After  consolidation  the  guardians  were  elected,  one  by  the  voters  of  each  ward. 
except  in  certain  boroughs  in  the  outskirts  of  the  city,  and  excepting  also  that  no 
election  was  held  in  the  21st,  22nd,  and  23rd  wards.  The  board  of  guardians 
elected  their  president  and  other  officers  ;  numerous  duties  and  powers  were  vested 
in  them,  and  they  were  required  to  report  annually  a  statement  of  their  expenses 
and  receipts.  Many  abuses  seem  to  have  existed  during  the  administration  of  the 
board  thus  elected,  particularly  in  its  latter  days,  when  it  became  known  deri- 
sively as  the  "board  of  buzzards."     It  was  abolished  by  an  act  of  assembly  of 


HISTORICAL  MEMORANDA  OF  THE  PHILADELPHIA  ALMSHOUSE.       87 

April  7,  1859,  which  directed  that  the  board  of  guardians  should  thereafter  be 
appointed,  three  by  the  district  court,  three  by  the  court  of  common  pleas,  and 
three  by  the  common  council ;  one  every  year  for  three  years  ;  and  in  ca.se  of 
vacancy  the  appointing  powers  were  to  fill  such  vacancy. 

By  an  act  of  June  2,  1871,  the  election  of  the  guardians  was  placed  entirely 
with  councils.  They  elected  four  persons  annually  to  serve  three  years,  the  minor- 
ity party  being  represented  in  the  board,  which  was  to  be  a  department  of  the 
city,  subject  to  the  act  of  1858,  and  could  not  make  a  contract  which  would  bind 
the  city  unless  an  appropriation  for  the  same  had  previously  been  made  by  the 
councils.  The  management  of  the  almshouse  and  hospital  continued  under  the 
board  of  guardians  thus  elected  until  the  act  entitled  ' '  an  act  to  provide  for  the 
better  government  of  cities  of  the  first-class  of  this  commonwealth,"  familiarly 
known  as  the  ' '  Bullitt  bill, ' '  came  into  force  on  the  first  Monday  of  April,  1887. 
Under  this  act  the  executive  power  is  vested  in  the  mayor  and  certain  departments, 
one  of  which  is  known  as  the  department  of  charities  and  correction,  which  is 
under  the  charge  of  a  president  and  four  directors,  to  whom  are  confided  the  care, 
management,  administration,  and  supervision  of  the  almshouse,  hospital,  house  of 
correction,  and  other  similar  institutions,  the  government  of  which  is  intrusted  to 
the  city,  except  the  municipal  hospital  or  lazaretto,  or  institutions  under  any  board 
of  directors  of  city  trusts  now  existing. 

During  the  tenure  of  the  board  of  guardians  much  of  the  work  of  the  almshouse, 
including  the  supervision  of  the  hospital  and  of  the  insane  department,  was 
intrusted  to  standing  committees.  According  to  the  rules  of  the  board  published 
in  1861,  for  example  :  standing  committees  of  three  members  were  appointed  on 
outwards,  children's  asylum,  hospital,  insane  department,  classification  and  diet, 
manufacturing  department,  supplies,  farm  and  garden,  accounts  ;  and  a  committee 
of  five  members  on  support  and  bastardy  cases.  These  committees  had  much  to  do 
with  the  practical  work  of  the  hospital  and  other  parts  of  the  institution,  and  with  a 
few  changes  and  modifications  in  authority,  the  same  plan  of  committees  continued 
during  the  administration  of  the  different  boards  of  guardians.  The  hospital 
committee  in  particular  was  vested  with  great  power,  and  was  practically  the 
executive  committee  for  the  control  of  the  hospital  and  medical  matters  in  general. 
Although  invested  with  much  authority,  at  different  periods  its  range  of  power 
varied. 

The  board  of  charities  and  correction  is  sub-divided  into  two  bureaus,  appointed 
by  the  president,  one  known  as  the  bureau  of  charities,  the  other  as  the  bureau  of 
correction.  The  president  of  the  board  is  ex-officio  a  member  of  both  bureaus. 
The  bureau  of  charities  makes  a  report  furnishing  information  to  the  board  at  its 
monthly  meeting,  and  the  members  of  the  bureau  are  expected  to  visit  Blockley 
once  a  week,  while  all  the  members  each  of  the  board  are  expected  to  visit  the  alms- 
house at  least  once  a  month. 

The  first  board  of  directors  of  the  department  of  charities  and 
correction  was  composed  of  James  W.  White,  M.D.,  president ; 
and  Robert  Laughlin,  Richard  A.  Cleemann,  M.D.,  Richard  C. 
McMurtrie,  and  James  Stewart,  treasurer.  Dr.  White  had  been 
long  connected  with  the  management  of  the  maternity  hospital 
and'  other  charities.  Mr.  Laughlin  had  been  for  many  years  one 
of  the  managers  of  the  house  of  correction.     Dr.  Cleemann  was  a 


88       HISTORICAL  MEMORANDA  OF  THE  PHILADELPHIA  ALMSHOUSE. 

member  of  the  board  of  health.  Mr.  McMurtrie  and  Mr.  Stewart 
had  been  members  of  the  board  of  guardians,  where  their  services 
had  been  of  great  value  to  the  poor  and  sick  of  the  city.  The 
president,  and  the  directors  who  were  appointed  on  the  bureau 
of  charities,  gave  to  the  work  the  closest  personal  attention. 

In  May,  ]889,  Dr.  White  was  succeeded  as  president  of  the 
board  of  directors  by  Mr.  Laughlin,  and  Mr.  Galloway  C.  Morris 
was  appointed  a  director  to  complete  the  board.  Mr.  Morris 
resigned  in  December,  1889,  and  Mr.  John  Roberts,  a  well  known 
member  of  the  bar,  and  a  former  member  of  the  board  of  mana- 
gers of  the  house  of  correction,  was  appointed  in  his  place.  The 
board  as  at  present  constituted,  therefore  consists  of  Robert  Laugh- 
lin, president ;  Richard  A.  Cleemann,  M.D.,  Richard  C.  McMurtrie, 
John  Roberts,  and  James  Stewart,  treasurer.  With  boards  so 
constituted,  the  affairs  of  the  almshouse  have  been  conducted 
with  great  efficiency,  and  great  advances  and  improvements  have 
been  made.  An  account  of  many  of  these  improvements  will  be 
given  later. 


CHIEF  EXECUTIVE  OFFICER  OF  THE  ALMSHOUSE. 

The  present  superintendent  of  the  almshouse,  Mr.  George 
Roney,  assumed  the  duties  of  his  position  January  1,  1886,  and 
has  served  from  that  time  to  the  present,  under  the  last  board 
of  guardians,  and  the  department  of  charities  and  correction, 
energetically  carrying  forward  for  these  boards  many  of  the 
improvements  to  be  hereafter  detailed. 

For  many  years  the  chief  executive  officer  of  the  almshouse  was  known  as  the 
steward.  According  to  the  rules  of  1861,  under  the  direction  of  the  board,  he  was 
to  have  entire  supervision  of  the  institution  in  all  its  various  departments,  except 
those  under  the  immediate  charge  of  the  medical  board  and  resident  physician  of  the 
insane  department.  The  details  of  his  authority  are  given  in  the  rules  printed  in  this 
and  other  years.  In  1876,  the  office  of  steward  was  abolished,  and  that  of  superin- 
tendent, with  some  enlargement  of  powers,  was  substituted.  The  superintendent 
supervises  all  the  departments  of  the  institution,  and  reports  any  inefficiency  of 
the  employees  to  the  board  ;  he  also  makes  suggestions  as  to  repairs  on  the  build- 
ings, and  is  invested  with  much  power  and  many  duties,  as  detailed  in  the  rules 
published  at  various  periods. 


HISTORICAL  MEMORANDA  OF  THE  PHILADELPHIA  ALMSHOUSE.       89 
REMOVAL  OF  THE  ALSMSHOUSE  TO  ITS  PRESENT  LOCATION. 

The  name  "  Blockley,"  which  is  so  commonly  applied  to  the 
Philadelphia  Almshouse  is  taken  from  the  township  in  which 
it  was  located.  Before  1854,  Philadelphia,  like  other  counties  of 
the  State,  was  divided  into  townships,  and  that  known  as  Block- 
ley  was  situated  on  the  west  side  of  the  Schuylkill.  While  famil- 
iar to  most  residents  of  the  city,  the  name  is  not  always  under- 
stood by  others,  and  we  have  been  asked  about  its  origin  by 
students  and  physicians. 

As  early  as  February,  1810,  an  effort  was  made  to  remove  the 
almshouse  to  a  farm;  and  that  year  a  report  was  made  to  the 
assembly,  but  without  apparent  result.  In  February,  1811,  the 
guardians  memoralized  the  legislature  for  authority  to  sell  the 
property  between  Tenth  and  Eleventh,  Spruce  and  Pine  streets, 
and  buy  a  farm.  They  also  desired  that  the  keeper  of  the  Arch 
street  prison  should  be  obliged  to  receive  all  drunken,  idle  and  dis- 
orderly persons.  The  committee  reported  against  the  desired  sale, 
and  it  was  not  until  the  passage  of  an  act,  March  5,  1828,  that 
authority  was  given  to  build  accommodations  suitable  for  a  hos- 
pital, an  almshouse,  etc.,  on  a  site  not  exceeding  two  miles  from 
Market  and  Broad  streets.  In  a  volume  printed  in  1828,  contain- 
ing the  rules  for  the  government  of  the  board  of  guardians,  and 
also  the  laws  relating  to  the  relief  and  employment  of  the  poor  in 
the  city  of  Philadelphia,  etc.,  the  full  text  of  this  act  is  to  be  found, 
and  from  it  we  will  cite  one  or  two  of  the  most  important  para- 
graphs. 

The  act  states  that  immediately  after  the  election  of  guardians  of  the  poor,  on 
the  third  Monday  in  May,  the  select  and  common  councils  of  the  city  of  Philadel- 
phia and  the  commissioners  of  the  neighboring  districts,  shall  elect  twelve  respect- 
able citizens,  within  the  bounds  of  their  respective  jurisdictions,  who  shall  be 
styled  the  "Commissioners  for  erecting  buildings  for  the  accommodation  of  the 
poor."  These  commissioners  were  to  form  a  board  and  make  one  of  their  own 
number  president. 

The  act  goes  on  to  say,  "It  shall  be  the  duty  of  the  said  commissioners,  having 
first  obtained  the  approbation  of  the  board  of  guardians  to  purchase  a  suitable  site,  not 
exceeding  two  miles  from  Market  and  Broad  streets,  the  title  whereof  shall  be  vested 
in  said  corporation,  for  the  erection  of  buildings  suitable  for  a  hospital,  almshouse, 
house  of  employment  and  children's  asylum,  and  to  cause  as  soon  as  practicable, 
the  necessary  buildings  as  aforesaid,  to  be  erected  and  constructed,  upon  such  plan 
or  plans  as  a  majority  of  said  commissioners  may  think  proper  for  the  purpose  con- 
templated, such  plan  or  plans  having  first  been  submitted  to,  and  approved  by,  the 
said  board  of  guardians,  having  due  regard  to  the  full  and  comfortable  provision  for 
all  such  persons  as  may  require  medical  or  surgical  aid,  and  also  such  as  may  be 


90      HISTORICAL  MEMORANDA  OF  THE  PHILADELPHIA  ALMSHOUSE. 

unable,  through  age  or  other  infirmities,  to  procure  subsistence,  and  for  the  employ- 
ment of  all  those  who  may  be  able  to  work,  and  also  for  the  health,  convenience  and 
instruction  of  the  children  ;  to  make  all  necessary  contracts  for  materials,  etc." 


"In  order  to  carry  the  objects  and  provisions  of  the  law  into  complete  effect, 
it  shall  and  may  be  lawful,  and  said  guardians  of  the  poor  are  hereby  author- 
ized and  invested  with  full  power  to  negotiate  and  contract  for  and  upon  the 
faith  of  the  said  corporations  of  the  guardians  of  the  poor,  any  loan  or  loans,  from 
time  to  time,  according  to  their  discretion,  not  exceeding  two  hundred  and  fifty 
thousand  dollars,  upon  the  best  terms,  and  lowest  rate  of  interest,  payable  half- 
yearly  :  and  the  said  corporation  of  the  guardians  of  the  poor  shall  receive  the 
amount  of  said  loans,  and  are  hereby  authorized  and  required  to  issue  certificates  of  the 
stock,  duly  attested  by  the  president  and  secretary  of  the  board  of  guardians,  under 
the  corporate  seal,  for  any  sum  or  sums  not  less  than  one  hundred  dollars  each,  as 
may  from  time  to  time  be  necessary,  in  pursuance  of  the  contracts  for  such 
loans,  etc." 

We  have  had  the  opportunity  of  examining  a  copy  of  the 
original  deed  or  "  written  indenture,"  conveying  the  Blockley 
property  from  Henry  Beckett,  and  Mary,  his  wife,  to  the  board  of 
guardians,  and  we  will  quote  as  much  of  this  as  indicates  the  price 
paid  and  exact  boundaries  of  the  land  bought — with  the  capitals, 
and  entire  want  of  punctuation  as  in  the  original. 


"THIS  INDENTURE 

"Made  the  first  day  of  January  in  the  year  of  our  Lord  one  thousand  eight  hun- 
dred and  twenty-nine  between  Henry  Beckett  of  the  City  of  Philadelphia  Mer- 
chant and  Mary  his  wife  of  the  one  part  and  the  Guardians  for  the  Relief  and 
Employment  of  the  Poor  of  the  City  of  Philadelphia  the  District  of  Southwark  and 
the  Townships  of  the  Northern  Liberties  aud  Penn  Witnesseth  that  the  said  Henry 
Beckett  and  Mary  his  wrife  for  and  in  consideration  of  the  sum  of  Fifty-one  Thous- 
and Five  Hundred  and  Twenty-eight  Dollars  Twelve  and  a  Half  Cents  lawful  money  to 
them  in  hand  paid  by  the  said  the  Guardians  for  the  Relief  and  Employment  of  the 
Poor  of  the  City  of  Philadelphia  the  District  of  Southwark  and  the  Townships  of 
the  Northern  Liberties  and  Pemi  at  the  time  of  the  execution  hereof  the  receipt 
whereof  is  hereby  acknowledged  have  granted  bargained  sold  released  and  con- 
firmed and  by  these  presents  do  grant  bargain  sell  release  and  confirm  unto  the 
said  the  Guardians  for  the  Relief  and  Employment  of  the  Poor  of  the  City  of  Phila- 
delphia, the  District  of  Southwark  in  the  Township  of  the  Northern  Liberties  their 
successors  and  assigns  All  that  Certain  Tract  Plantation  and  parcel  of  land  situate 
on  the  west  side  of  the  River  Schuylkill  in  the  Township  of  Blockley  and  County 
of  Philadelphia  in  the  state  of  Pennsylvania  Being  part  of  a  certain  larger  tract 
of  land  known  by  the  name  of  the  Woodlands  bounded  and  described  agreeably  to 
a  resurvey  thereof  lately  made  by  Enoch  Lewds  Esquire  as  follows  Beginning  at 
a'  Post  on  the  margin  of  the  River  Schujdkill  at  low  water  mark  in  the  mouth  of  a 


HISTORICAL  MEMORANDA  OF  THE  PHILADELPHIA  ALMSHOUSE.       91 

small  creek  and  at  the  corner  of  land  belonging  to  John  Hare  Powell  and  Edward 
S  Burcl  Esquire  thence  up  the  creek  by  the  land  of  the  said  Powell  and  Burd 
north  thirty-six  degrees  and  two-thirds  of  a  degree  west  nineteen  perches  and  one- 
sixteenth  of  a  perch  to  a  post  north  fifty-three  degrees  west  twenty-three  perches 
to  a  post  thence  leaving  the  creek  but  still  along  the  line  of  Powell  and  Burds 
land  north  forty-nine  degrees  and  a  half  west,  one  hundred  and  eight  perches  to  a 
post  on  the  southern  side  of  the  Darby  Road  south  sixty-two  degrees  and  a  quarter 
west  one  hundred  and  three  perches  and  a  quarter  of  a  perch  to  a  comer  of  Thomas 
Fleming's  land  thence  by  the  said  Fleming's  land  south  twenty-six  degrees  east 
seventy -nine  perches  and  four-tenths  to  a  post  in  a  small  stream  of  water  thence  south 
ten  degrees  west  twenty-one  perches  and  five-tenths  of  a  perch  to  a  post  thence  south 
one-quarter  of  a  degree  east  fifty-one  perches  and  seven-tenths  of  a  perch  to  the  low 
water  mark  of  the  River  Schuylkill  and  thence  up  the  said  river  by  the  several 
meanders  thereof  two  hundred  and  sixty-two  perches  more  or  less  to  the  place  of 
beginning  Containing  one  hundred  and  eighty-seven  acres  and  sixty  perches  of 
land  Being  the  same  tract  of  land  and  premises  which  Jacob  Strembeek  Esquire 
High  Sheriff  of  the  City  and  County  of  Philadelphia  by  Deed  Roll  stated  the  eighth 
day  of  December  last  past  granted  and  conveyed  with  the  said  Henry  Beckett,  in 
fee  seized  and  sold  by  virtue  of  legal  proceedings  issued  out  of  the  District  Court 
for  the  City  and  County  of  Philadelphia  as  the  property  of  William  Hamilton 
Esquire  deceased  at  the  suit  of  Margaret  Hamilton  as  in  and  by  the  said  recited 
Deed  Roll  duly  acknowledged  and  entered  among  the  Records  of  the  said  Court  in 
Book  E  page  231  and  will  more  fully  appear  together  with  all  and  similar  the 
buildings  improvements  marsh  cripple  landing  landing  places  ways  waters, 
water-coui-ses  rights  libei-ties  privileges  hereditaments  and  appurtenances  what- 
soever thereunto  belonging  or  in  any  wise  appertaining  and  the  Reversions  Remain- 
ders rents  issues  and  profits  thereof  and  all  the  estate  right  trite  interest  prop- 
erty claim  and  demand  whatsoever  of  him  the  said  Henry  Beckett  and  Mary  his 
wife  etc. ' ' 

Just  when  the  work  was  begun  on  the  Blockley  Almshouse,  the 
time  taken  to  complete  the  buildings,  the  order  in  which  they 
were  finished,  and  exactly  when  they  were  first  occupied,  is 
not  on  record  in  any  publications  to  which  we  have  had  access. 
The  statements  made  generally  are  that  the  buildings  were 
occupied  about  1833,  1834  or  1835.  Dr.  Carson  in  his  history  of 
the  University  of  Pennsylvania,  page  201,  says  that  the  hospital 
department,  the  first  portion  of  the  pile  of  buildings,  afterwards 
completed  on  the  west  bank  of  the  Schuylkill  river,  was  in  suffi- 
cient readiness  upon  the  first  visitation  of  cholera  in  1832,  to 
receive  patients.  The  correctness  of  this  statement  seems  to  be 
doubtful.  A  search  of  the  manuscript  minute  books  of  the  board 
of  guardians  from  1828  to  1835,  inclusive,  indicates  that  work 
probably  began  late  in  1830  or  early  in  1831,  and  was  carried  on 
steadily  until  1835.  May  27,  1833,  the  building  commissioners 
reported  that  two   buildings  would  be  ready  for  their  inmates 


92      HISTORICAL  MEMORANDA  OF  THE  PHILADELPHIA  ALMSHOUSE. 

on    October   1,   1833,   and    that    the   two   others   then    erecting 
would  be  finished  during  the  course  of  the  next  season,  1834. 

From  the  minutes  of  the  board  of  guardians  we  learn  that  the  final  removal 
commenced  on  the  Monday  following  July  7, 1834,  and  continued,  under  the  super- 
vision of  three  committees  of  the  board,  until  July  28th,  when  1he  "Old  Alms- 
house" was  finally  vacated  and  the  new  one  actually  taken  possession  of,  as  the 
following  records,  from  the  minutes,  July  28,  1834,  proves  : — 

"Resolved,  that  the  president  cause  public  notice  to  be  given,  in  the  daily  papers 
of  the  city,  of  the  occupancy  of  the  new  almshouse  and  the  removal  of  the  office." 

"  On  motion  the  board  adjourned  to  proceed  over  the  Schuylkill  to  meet  in  the 
new  almshouse." 

"The  board  met  agreeably  to  adjournment,  July  28,  1834,  being  the  first  regu- 
larly organized  meeting  of  the  board  on  the  west  side  of  the  Schuylkill." 

The  following  is  a  copy  of  the  card  of  the  first  inmate  of  the  "  New  Almshouse," 
or  at  least  of  the  oldest  admission  card  preserved,  which  is  kept  framed  at  the  insti- 
tution : — 

' '  Mary  Cannon,  Blk. 

Age  23.     Lewiston,  Del.,  Aug.  22,  '33.     J.  Huley. 

Surgical.     N.  D.  B.     1840.     J.  Huley. 

Asst.  Hosp.  6-29-66. 

Medical         1-15-67.     Willard-     C 

Discharged  8-21-67.     Curtin.       C. 

Asst.  Hosp.  8-31-67.     R.  H.  B. 

Medical         3-22-78.     Vogler. 

Died  1878." 

It  is  possible  that  this  woman  may  have  been  transferred  from  Spruce  street  when 
the  transfers  were  made,  and  a  new  card  made  out  under  the  original  date  of 
admission  in  the  old  almshouse,  or  she  may  have  been  admitted  to  Blockley  before 
the  completion  of  the  building. 

January  19,  1835,  the  commissioners  sent  a  communication  to 
the  guardians  that  they  would  surrender  the  new  almshouse 
buildings,  completed,  March  1,  1835. 


TRANSFERS  AND  SALES  OF  ALMSHOUSE  LANDS. 

While  the  main  buildings  have-  remained  much  the  same, 
great  changes  have  taken  place  in  the  distribution  and  owner- 
ship of  the  original  one  hundred  and  eighty-seven  acres  and 
sixty  perches  of  land  which  constituted  the  old  almshouse  farm. 
Under  an  act  of  the  legislature  approved  May  1,  1861,  much  of 
the  property  has  been  sold  or  transferred.  The  full  text  of  this 
important  act  is  as  follows : — 


HISTORICAL  MEMORANDA  OF  THE  PHILADELPHIA  ALMSHOUSE.       93 

Section  1.  Be  it  enacted  by  the  Senate  and  House  of  Representatives  of  the 
Commonwealth  of  Pennsylvania  in  General  Assembly  met,  and  it  is  hereby  enacted 
by  the  authority  of  the  same.  That  the  city  of  Philadelphia  is  hereby  empowered 
to  make  private  or  public  sale,  and  convey  in  fee  simple  or  reserving  ground  rents, 
the  present  almshouse  grounds,  or  any  part  thereof,  situate  in  the  twenty-seventh 
ward  of  the  city,  containing  one  hundred  and  eighty-seven  acres,  more  or  less,  and 
the  buildings  thereon  erected,  subject  to  the  following  conditions  : — 

1.  That  the  city  of  Philadelphia  shall  reserve  a  part  of  said  ground,  not  exceed- 
ing forty  acres,  to  be  laid  out  and  maintained  as  an  open  public  place  forever,  for 
the  health  and  recreation  of  the  people. 

•2.  That  the  said  city  shall  also  reserve  at  Pine  and  South  streets,  on  the  river 
Schuylkill,  pieces  of  ground  sufficient,  in  the  opinion  of  the  chief  engineer  and 
surveyor  of  said  city,  for  abutments  and  approaches  thereto,  for  a  bridge  or  bridges, 
which  may  be  lawfully  authorized  to  lie  erected  at  either  of  said  streets. 

Sec.  2.  That  the  city  of  Philadelphia  is  hereby  empowered  to  purchase  land  and. 
erect  thereon  an  almshouse  or  poorhouse  (with  or  without  a  house  of  correction  and 
employment,  as  may  be  deemed  expedient),  and  in  payment  thereof  to  create  a 
loan  which  shall  be  exempt  from  state  tax. 

Sec.  3.  That  the  proceeds  arising  from  the  sale  of  the  grounds  and  buildings 
specified  in  the  first  section  of  this  act  shall  be  specifically  applied  to  and  pledged 
for  the  purpose  of  payment  of  the  loan  authorized  by  the  second  section  of  this  act ; 
and  if  ground  rents  shall  be  reserved,  or  mortgages  taken  in  payment,  the  same, 
when  sold  or  paid  off,  shall  be  applied  to  and  for  the  same  purpose. 

Approved  May  1,  1861. 

Under  the  conditions  of  this  act  which  required  that  Philadel- 
phia should  reserve  a  portion  of  the  almshouse  grounds  as  an 
open  public  place  forever,  an  ordinance  was  passed  by  councils  in 
July,  1883,  of  which  the  following  is  the  first  section. 

The  select  and  common  councils  of  the  city  of  Philadelphia  do  ordain, 
that  all  the  almshouse  property  in  West  Philadelphia,  bounded  by  South  street, 
Spruce  street,  Thirty-fourth  street,  Vintage  avenue,  on  to  the  southern  boundary 
of  the  city  property,  aud  thereto  to  the  Schuylkill  river,  be,  and  is,  hereby- set 
apart  for  the  purpose  of  being  improved,  for  the  health  and  public  welfare  of  the 
citizens  of  Philadelphia. 

In  1870,  a  tract  of  ten  and  a  half  acres  was  sold  by  the  city  to 
the  University  of  Pennsylvania  for  $8,000  per  acre.  In  1872,  six 
acres  were  donated  for  $500  for  the  hospital  of  the  university,  on 
condition  that  fifty  free  beds  should  be  reserved  for  the  sick  and 
wounded  of  the  city. 

In  1882,  the  city,  under  an  agreement  with  the  trustees  of  the 
university,  deeded  to  that  institution  fourteen  acres  more  of  the 
almshouse  land,  in  consideration  for  which  the  city  was  to  be  paid 
ten  thousand  dollars  and  was  to  be  entitled  to  fifty  free  scholar- 
ships in  the  university  forever.  These  free  scholarships  have  since 
been  distributed  among  the  pupils  of  the  high  and  other  public 


94      HISTOETCAL  MEMORANDA  OF  THE  PHILADELPHIA  ALMSHOUSE. 

schools  of  Philadelphia,  those  being  selected  who  have  passed 
best  in  competitive  examinations.  In  1888,  the  city  gave  to  the 
university  three-fourths  of  an  acre  opposite  medical  hall,  on 
Thirty-sixth  street,  on  condition  that  a  free  public  library  of 
reference  be  erected  on  the  university  grounds.  |In  1889,  the 
university  purchased  of  the  city  another  large  tract  of  almshouse 
ground,  chiefly  situated  between  Thirty-fourth  street,  the  Philadel- 
phia and  West  Chester  railroad,  Locust  and  South  streets,  pay- 
ing for  this  property  $149,000.  Owing  to  these  purchases  by 
the  University  of  Pennsylvania  and  the  erection  of  numerous 
buildings  bv  this  institution ;  also  because  of  the  construction  of 
railroads,  the  cutting  through  of  streets,  the  tearing  down  of  some 
buildings  and  the  erection  of  others  on  the  almshouse  property, 
the  topography  and  appearance  of  the  grounds  have  greatly 
altered. 

The  Pennsylvania  railroad  claims  a  lot  of  ground  formerly 
belonging  to  the  almshouse  property,  which  is  included  within 
the  curved  tracks  of  the  Philadelphia  and  West  Chester  railroad, 
the  Delaware  extension  of  the  Pennsylvania  railroad  and  the  curve 
upon  which  is  built  the  southern  track  connecting  the  two  rail- 
roads. This  ground  was  put  up  at  public  sale  under  an  ordinance 
of  January  11, 1882,  and  one  of  April  4,  1882.  The  transfer  was 
authorized  to  the  company,  on  condition  that  a  bridge  should  be 
built  over  Thirtieth  street  whenever  it  was  required  for  public 
use.  The  company  refused  to  accept  the  conditions  for  the  sale, 
and  claimed  to  have  taken  the  ground  by  eminent  domain,  but 
no  conveyance  of  the  property  above  men  lioned  from  the  city  to 
the  Pennsylvania  railroad  company  can  be  found  in  the  office 
of  recorder  of  deeds.  In  January,  1890,  a  resolution  was  passed 
by  the  select  and  common  councils  of  the  city  to  inform  the 
proper  officials  of  the  company  that  no  settlement  had  been  made 
for  the  land  taken  from  the  almshouse  park,  and  that  if  reason- 
able proposals  were  not  made,  the  city  solicitor  was  authorized  to 
apply  to  the  courts  for  a  jury  to  assess  the  value  of  the  property 
and  damages  to  be  paid  the  city. 


SOME  STATISTICAL  AND  HISTORICAL  FACTS. 

In  the  Annual  Statement  of  the  guardians  of  the  poor  for  1867, 
and  for  a  number  of  years  following,  are  given  under  the  head  of 
"  addenda,"  some  valuable  statistics  and  historical  facts  in  small 


HISTORICAL  MEMORANDA  OF  THE  PHILADELPHIA  ALMSHOUSE.       95 

compass,  which  we  will  quote,  arid  will  then  follow  with  a  descrip- 
tion of  the  grounds  and  the  buildings  as  they  are  at  present. 

1853.  Amount  of  damages  received  for  crossing  the  almshouse  grounds  by  the 
West  Chester  Railroad  Company,  $5,951.00. 

1857.  Gas  introduced.     Cost- of  pipes,  meter?,  fixtures,  etc.,  $5,992.35. 
1859.  Bakehouse  erected  ;  cost  $1,983.12. 

1859.  (July.)  Date  of  the  present  organization  of  the  board,  the  guardians  of  the 
poor  being  appointed  by  the  courts  and  councils. 

1860.  Workshop  erected  ;  cost  $4,465.43. 

1861.  Clinic  room,  rear  of  drug  store,  erected  ;  cost  $2,765.05.  The  old  clinic  room 
in  insane  department  floored  over,  and  divided  into  doctor's  office,  lecture  room,  etc. 

1862.  Sale  of  old  copper  roofing,  yielding  $35,070.78  ;  of  this  amount  there  has 
been  expended  for  re-roofing  $12,496.28,  leaving  a  balance  for  the  erection  of  a  new 
children's  asylum  of  $22, 57''. 50. 

1863-67.  Heating  by  steam,  and  also  ventilation,  introduced  generally. 

1865.  Amount  of  damages  paid  by  Junction  Railroad  Company  (connecting  with 
New  York  and  Washington)  for  crossing  the  almshouse  grounds,  $10,000.00. 

1867.  Soaphouse  erected. 

The  number  of  shade  and  fruit  trees  on  the  almshouse  grounds  is  771.  See  state- 
ment of  accounts  for  the  year  1861. 

The  quantity  of  land  pui-chased  for  the  almshouse  is"  187  acres,  1  rood  and  20 
perches.  The  almshouse  and  yard  within  occupies  10  acres  of  this,  the  remainder 
in  farm  and  garden. 

The  farm  cost  $51,761.81  ;  the  buildings  cost  $859,743.84.     Total,  $911,505.65. 

Present  valuation  (see  report  made  by  the  guardians  of  the  poor  to  the  commis- 
sioners of  the  sinking  fund  for  the  year  1867). 

Ground  value  at  $1,700,000.00  ;  buildings  valued  at  $500,000.00.  Total, 
$2,200,000.00,  being  an  excess  of  cost  of  $1,288,494.35. 


DESCRIPTION  OF  THE  PRESENT  ALMSHOUSE  GROUNDS. 

For  a  short  distance  from  Thirty-fourth  street  the  present  alms- 
house enclosure  is  bounded  on  the  north  by  Pine  street ;  and  a 
street  called  Guardian  avenue,  runs  from  Pine  street  to  the  eastern 
border  of  Woodlands  cemetery,  in  a  line  parallel  with  the  north- 
western of  the  four  main  structures,  therefore  bounding  the  enclo- 
sure on  the  northwest.  A  street,  called  Cleveland  avenue,  is 
marked  on  the  city  plan  between  Woodlands  and  the  almshouse. 
From  Pine  street,  for  about  a  block,  Thirty-fourth  street  bounds 
the  enclosure  on  the  east.  Vintage  avenue  runs  from  Thirty- 
fourth  street  to  Woodlands  cemetery  (or  Cleveland  avenue),  in  a 
line  parallel  with  the  front  or  southeastern  building,  forming  the 
southeastern  boundary  of  the  almshouse  enclosure. 


96       HISTORICAL  MEMORANDA  OF  THE  PHILADELPHIA  ALMSHOUSE. 

Beyond  Vintage  avenue  spreads  out  a  large  field — riverward  as 
far  as  the  railroads,  to  the  east  as  far  as  almshouse  lane,  and  to 
the  west  to  Woodlands.  On  the  city  plan,  but  not  yet  cut  through, 
is  Meadland  avenue,  situated  between  the  railroads  and  Vintage 
avenue,  and  parallel  with  the  latter.  Beyond  the  fields  are  the 
tracks  of  the  old  West  Chester  and  Philadelphia,  the  Junction 
railroad,  and  special  tracks  connected  with  the  Pennsylvania 
railroad  system.  Between  these  numerous  railroad  tracks  and 
the  river,  is  a  large  area,  formerly  like  the  ground  now  occupied 
by  the  tracks — a  swamp  or  marsh,  but  now  nearly  filled  to  the 
river  front  with  the  ashes  and  dirt,  which  under  a  city  ordinance, 
have  been  hauled  and  dumped  here  during  several  years. 

A  lane,  lined  on  both  sides  by  old  trees,  and  known  as  "Alms- 
house Lane,"  leads  from  Vintage  avenue,  near  Thirty-fourth  street, 
to  the  river.  It  is  the  road  to  the  old  almshouse  wharf,  to  which 
barges  and  vessels  came  with  coal  and  other  stores,  and  from 
which  sometimes  tugs,  small  boats  and  other  craft  started.  When 
inmates  of  the  house  of  correction  are  brought  to  work  on  the 
almshouse  grounds,  as  they  have  been  frequently  during  recent 
years,  they  are  usually  transported  on  a  tug  by  the  harbor  police, 
and  are  landed  at  this  wharf.  To  the  east  or  left  of  this  lane,  not 
far  from  Thirty-fourth  street,  is  an  old  frame  building,  now  occu- 
pied by  the  clerk  of  the  almshouse ;  and  to  its  right  or  west,  facing 
and  very  close  to  the  railroad  tracks,  is  an  old  stone  building  two 
stories  and  a  half  high,  also  usually  occupied  by  some  one  con- 
nected with  the  institution.  This  house  has  stood  for  many  years. 
It  formerly  marked  nearly  the  line  where  the  marsh  or  swamp  land 
ended,  which  was  first  occupied  by  the  railroad  tracks.  These  tracks 
were  built  on  trestles  and  the  space  afterwards  filled  in  with  dirt. 

Between  Thirty-fourth  street  and  the  river,  and  east  of  alms- 
house lane,  are  the  old  farm  house  and  barn,  with  connected 
stables,  sheds  and  buildings.  This  farm  house,  well  built  and 
roomy,  stands  on  a  knoll,  and  is  now  used  as  the  children's  asylum. 
The  barn  is  a  large  substantial  structure  of  stone,  built  like  the 
great  buildings  of  the  quadrangle  to  withstand  the  ages.  On  the 
southeastern  corner  of  Thirty -fourth  and  Spruce  streets  is  a  frame 
house  of  comparatively  recent  date,  occupied  by  one  of  the  officials 
of  the  almshouse.  Between  Almshouse  lane  and  South  street, 
beyond  the  barn  and  old  frame  house,  is  a  large  lot  which  is  occu- 
pied by  the  water  department,  and  is  used  for  the  storage  of  pipes 


HISTOEICAL  MEMORANDA  OF  THE  PHILADELPHIA  ALMSHOUSE.       97 

and  other  materials.  A  large  city  free  bath  house  is  situated 
along  the  approach  to  the  South  street  bridge.  Between  the 
approach  to  South  street  and  Almshouse  lane,  and  between  the 
water  department  enclosure  and  the  railroad,  is  an  irregular  area, 
at  present  used  as  a  general  thoroughfare. 

The  position  of  the  South  street  bridge  and  its  western  ap- 
proaches to  the  almshouse  buildings  are  somewhat  misleading. 
The  bridge  has  not  been  constructed  on  a  line  with  South  street 
as  laid  out  on  the  city  plan  east  of  the  river,  but  runs  in  a  direc- 
tion from  northwest  to  southeast.  Lombard  and  South  streets, 
if  cut  through  on  the  west  side  of  the  river  in  a  line  with  the 
other  streets,  would  run  through  the  almshouse  property.  On 
the  west  side  of  the  river,  however,  the  approach  to  the  South 
street  bridge  is  on  the  same  line  as  the  bridge  itself  until  it 
merges  into  Spruce  street  near  Thirty-fourth. 

North  of  the  almshouse  enclosure  and  grounds  as  just  described, 
much  of  the  old  almshouse  farm,  as  already  shown,  is  now  in  pos- 
session of  the  University  of  Pennsylvania.  On  a  portion  of  a  tri- 
angular lot  bounded  by  Thirty-sixth  street  and  by  Spruce  street 
and  Woodland  avenue  where  they  cross  at  a  sharp  angle,  has  been 
erected  one  of  the  city  police  stations.  On  another  part  of  this  lot, 
facing  Spruce  street,  still  stands,  in  good  condition,  an  old  farm- 
house with  dormer  roof,  which  was  for  a  long  time  the  residence 
of  the  physician-in-chief  of  the  insane  department.  In  1888,  as 
already  stated,  three-fourths  of  an  acre  from  this  lot  was  given 
to  the  universit}^. 

For  many  years  the  cemetery  connected  with  the  present  alms- 
house was  situated  in  a  part  of  the  grounds  which  would,  as  the 
streets  are  laid  out  now,  be  between  Locust  and  Spruce  streets, 
and  west  of  Thirty-second  street.  The  present  cemetery  is  situ- 
ated west  of  the  southeastern  frontage  of  the  buildings,  between 
them  and  the  Schuylkill.  It  covers  about  an  acre;  is  surrounded 
on  three  sides  by  a  close  board  fence,  and  on  one,  the  east,  by  a 
pale-fence,  in  the  centre  of  which  is  a  gateway.  The  fences,  and 
the  cemetery  in  general,  have  a  somewhat  dilapidated  appearance, 
but  as  I  am  informed  by  the  superintendent,  steps  are  about  to 
be  taken  to  improve  this  burying  ground,  in  line  with  the  general 
progress  of  improvement  in  the  entire  institution.  This  little  plot 
has  its  full  measure  of  weirdness  and  quaintness ;  two  old  trees, 
gaunt  and  gnarled,  stand  sentinel  over  the  humble  mounds  and 

7 


98      HISTORICAL  MEMORANDA  OF  THE  PHILADELPHIA  ALMSHOUSE. 

waiting  trenches.  In  all  the  enclosure,  but  one  grave  is  marked — 
a  solitary  wooden  tablet,  with  a  brief  inscription.  Built  against  the 
board  fence  on  the  north  side  is  a  home-made  hut  about  twelve 
feet  long  and  half  as  inany  feet  in  width,  the  abode  during  the  day- 
time of  a  one-legged  Argus,  who  guards  these  sacred  precincts,  and 
regales  visitors  with  harrowing  stories  of  the  place;  but  when  night 
arrives  betakes  himself  to  his  quarters  in  the  buildings  that  his 
sleep  may  not  be  disturbed  by  visions  of  the  scenes  of  which  he 
is  the  custodian  and  narrator. 


DESCRIPTION  OF  THE  PRESENT  ALMSHOUSE  BUILDINGS. 

A  general  description  of  the  present  arrangement  of  the  build- 
ings of  the  almshouse,  and  also  of  the  uses  to  which  these  build- 
ings or  certain  portions  of  them  are  put,  may  be  of  value  hereafter 
to  those  in  search  of  information  with  reference  to  the  history  of 
this  institution.  The  description  is  from  personal  observations 
and  from  data  furnished  by  the  superintendent  of  the  almshouse, 
and  the  chief  resident  physician  of  the  hospital. 

The  four  main  buildings  of  the  almshouse  surround  a  hollow  square,  leaving, 
however,  a  considerable  open  space  between  the  ends  of  the  buildings.  They  are 
built  of  stone  ;  three  of  them  are  three  stories  high  with  dormer  roofs.  Formerly 
all  were  full  three  stories  in  height,  but  after  the  fire  in  1S85,  which  partially  de- 
stroyed the  insane  departnifnt,  the  southwestern  structure  was  only  rebuilt  to  two 
stories,  as  w;ll  be  hereafter  described. 

In  describing  the  position  of  these  buildings  with  reference  to  the  Schuylkill  river, 
and  the  city  streets  which  have  now  been  cut  through  and  completed  around  the  alms- 
house, mistakes  might  be  made  by  a  too  hasty  observer.  Commcnly  the  four  great 
buildings  which  bound  the  quadrangle  are  described  as  north,  south,  east  and  west, 
but  they  are  not  located  with  the  direct  points  of  the  compass.  Instead  of  a  north- 
ern, southern,  eastern  and  western  main  building,  we  have  in  general  terms  a  north- 
western, a  southeastern,  a  northeastern  and  a  southwestern  building,  the  southeast- 
ern being  the  main  or  front  building,  with  the  elevated  portico  in  the  centre.  The 
river  which  runs  nearly  north  and  south  just  above  the  almshouse  property,  oppo- 
site and  below  it,  or  above  and  about  the  position  of  Gray's  Ferry  bridge,  takes  a 
sweep  to  the  west  or  southwest. 

The  front  or  main  building  facing  southeast,  is  521.6  feet  long  by  60  feet  wide. 
Its  centre  is  chiefly  used  as  an  administration  building,  and  as  residences  for  the 
superintendent  and  others.  The  lower  or  first  floor  extends  beneath  the  immense 
portico  of  eight  columns,  which  is  on  a  level  with  the  second  floor,  and  is  ap- 
proached by  steep,  stone  stairways  on  the  east  and  west.  On  this  lower  floor  are  the 
offices  of  the  hou«e  agent,  the  dining-room  for  the  officers  and  inmates,  and  a 
clothes-room  for  the  men.  The  second  floor  of  the  centre  is  occupied  by  the  offices 
of  the  president  and  directors  of  the  board  of  charities  and  correction,  and  of  the 


i    /a 


HISTORICAL  MEMORANDA  OF  THE  PHILADELPHIA  ALMSHOUSE.       99 

superintendent ;  the  third  floor  by  the  private  apartments  of  the  superintendent, 
and  the  dining-room  of  the  resident  j>hys:cians.  East  of  the  centre,  the  first,  second, 
and  third  floors  are  occupied  by  male  pauper  inmates  or  "  ontwarders, "  as  they  are 
sometimes  called,  maoy  of  them  in  this  portion  being  able  to  work  about  the  build- 
ings and  grounds  in  the  different  departments.  West  of  the  centre,  the  first,  sec- 
ond and  third  floors  are  also  occupied  by  male  paupers  or  outwarders,  but  those 
congregated  here  are,  in  the  main,  the  oldest  and  most  infirm.  The.  attic  of  this 
building  is  used  as  a  store-room,  and  also  as  sleeping  apartments  for  the  officers  and 
for  the  superintendent's  servants. 

The  northeastern  building  bounding  the  quadrangle  includes  most  of  the  depart- 
ments of  the  Philadelphia  Hospital  proper.  It  is  three  stories  high,  with  dormer 
roof,  and  is  540  feet  long  and  63  feet  wide.  The  centre  is  occupied  by  female 
eye,  skin  and  surgical  wards,  and  by  the  men's  surgical  wards.  The  Protestant 
Episcopal  chapel  is  also  located  there.  In  the  yard  east  of  the  centre,  and  con- 
nected by  a  covered  corridor  with  the  main  building,  is  the  amphitheatre  or 
clinical  lecture  room,  54  by  66  feet  in  extent,  and  having  a  seating  capacity  for 
about  four  hundred  ;  it  was  built  in  1861.  The  first  floor  at  the  north  end  of  this 
northeastern  building  is  occupied  by  the  library,  the  offices  of  the  chief  resident 
physician,  and  the  dining-room  for  nurses.  Built  eastward  from  this  end  is  a  one- 
story  brick  building  erected  by  the  Mary  Shields'  legacy  fund.  It  is  76  feet  long  by 
20  feet  wide,  and  is  used  as  a  general  kitchen  for  the  hospital,  and  also  as  an  apart- 
ment for  special  diet  for  patients.  The  first  floor  at  the  southern  end  of  the  north- 
eastern building  is  occupied  by  the  offices,  recitation  rooms  and  parlor  connected 
with  the  training  school  for  nurses,  and  also  by  the  drug  department  In  the 
second  story  north  are  the  female  medical  wards  ;  in  the  centre  are  the  men's 
venereal  and  skin  wards  ;  in  the  south  the  nurses'  dormitories.  The  third  floor, 
centre  and  north,  contains  the  men's  medical  wards  ;  south,  the  infirmary  and 
dormitories  for  the  nurses.  The  attic  of  this  entire  building  is  occupied  as  a  sleep- 
ing apartment  for  attendants,  and  for  convalescent  patients  of  the  men's  medical 
and  surgical  wards. 

The  northwestern  main  building  is  three  stories  high,  with  dormer  roof,  and  is 
521.6  feet  long  and  60  feet  wide.  The  first  floor  in  the  centre  is  occupied  by  the 
Methodist  Episcopal  chapel,  the  women's  outward  dining-room  and  a  clothes-room  ; 
on  the  second  floor  centre,  are  the  private  apartments  of  the  chief-resident  physi- 
cian and  the  office  and  sleeping-room  of  the  matron  ;  on  the  third  floor  are  the 
sleeping  apartments  of  the  resident  physicians.  The  first  floor  east  is  occupied  by 
the  women's  nervous  wards  ;  the  second  by  the  nursery,  and  the  third  by  the  ward 
for  diseases  of  women.  On  the  first  floor  west,  are  the  women's  outwards  and  the 
Eoman  Catholic  chapel  ;  on  the  second  and  third  floors  also  the  women's  outwards  ; 
and  on  the  third,  in  addition  to  the  outwarders,  the  wonien-help  for  different 
departments  are  quartered.  In  the  eastern  attic  of  this  northern  building  are  the 
women's  venereal  wards  ;  while  in  the  centre  and  west  attics  are  the  quarters  for 
the  working  women  of  different  departments. 

The  southwestern  structure  bounding  the  quadrangle  is  the  main  building  of  the 
insane  department,  which  was  formerly  three  stories  in  height  throughout  like  the 
other  three  buildings,  but  after  the  fire  in  1885,  only  sixty-six  feet  of  the  centre 
was  rebuilt  to  three  stories,  the  extensions  on  each  side  from  the  centre  being  only 
carried  up  to  two  stories.  The  full  length  of  the  building  is  298  feet ;  its  width 
63  feet.  In  the  centre  on  the  first  floor  are  the  offices  for  the  physicians  and  the 
reception  rooms  for  the  patients  and  their  friends  ;  on  the  second  floor  the  sleeping 


100    HISTORICAL  MEMORANDA  OF  THE  PHILADELPHIA  ALMSHOUSE. 

apartments  of  the  doctors  and  tbe  sewing  room  ;  on  the  third  floor  an  amusement 
hall.  The  first  and  second  floors  to  the  north  of  the  centre  are  occupied  by  female 
insane  patients  ;  the  first  and  second  floors  on  the  south  side  by  male  patients. 
Two  wings  built  in  1870,  from  each  end  of  this  western  main  building,  each 
extend  237  feet  west,  and  have  a  width  of  48  feet  They  are  built  of  stone  and 
are  three  stories  high.  The  north  wing  is  occupied  by  female  insane  patients,  and 
the  south  by  male  patients. 

These  buildings  have  the  great  advantages  of  room,  strength 
and  solidity.  The  walls  of  the  four  immense  buildings  which 
bound  the  quadrangle  are  of  great  thickness,  and  have  been 
erected  upon  stone  and  brick  archways  with  sturdy  foundations. 
Whatever  through  mischance,  abuse,  or  alteration  may  have 
occurred  to  the  inside  of  these  robust  structures,  the  walls  have 
stood  unshaken,  and  they  promise  to  stand  through  many  genera- 
tions. 

In  the  centre  of  the  hollow  square  formed  by  the  four  main  buildings  are  located 
the  boiler  and  engine  rooms  for  generating  steam  for  the  entire  establishment ;  an 
electric  light  plant  with  dynamo  ;  a  store  house  from  which  all  the  supplies  are 
distributed  ;  the  manufacturing  department,  the  bui'dings  for  which  contain  a 
steam-fitting,  tin,  paint,  carpenter,  wheelwright,  upholsterer,  plumber,  blacksmith, 
tailor  and  shoe  shops  ;  shops  for  h;>nd  loom  weaving  ;  and  the  bakery,  tallow  ren- 
dering, soap  boiling  and  blanket  scouring  departments.  The  brick  building  used 
as  a  kitchen  for  the  out  wards,  93  feet  long  and  20  feet  wide,  built  from  the  pro- 
ceeds of  the  Mary  Shields'  legacy,  is  also  located  here.  All  the  buildings  of  the 
entire  institution  are  heated  by  steam. 

Two  large  fire  escapes  built  of  brick  are  attached  to  the  hospital  or  northeastern 
building,  and  are  connected  with  the  different  wards  by  an  iron  balcony  running 
the  entire  length  of  the  same  on  each  floor.  A  fire  escape  of  the  same  kind 
is  attached  to  each  wing  of  the  insane  building  ;  these  are  connected  by  an  open 
bridge  from  each  floor.  The  northwestern  and  southeastern  main  buildidgs  have 
also  iron  fire  escapes,  running  from  the  ground  to  the  top  of  the  buildings.  The 
grounds  are  beautifully  laid  out,  well  sodded,  and  with  a  large  number  of  shade 
trees,  shrubbery  and  plants. 

East  of  the  hospital  buildings,  to  the  left  of  the  roadway  wrhich  leads  to  the  clinic 
hall  are  four  brick  pavilions.  Three  are  two-story  brick  structures  connected  by  a 
covered  porch,  and  occupied,  with  the  exception  of  one  ward,  which  is  the  men's 
eye  ward,  by  the  men's  nervous  wards.  Each  of  these  tnree  pavilions  is  114  feet 
long  by  28  feet  wide.  Between  these  and  the  main  building  is  a  one-story  brick 
pavilion  parallel  with  the  northeastern  main  building  ;  this  pavilion  is  used  as  a 
dining-room  for  many  of  the  patients  in  the  nervous  wards.  Opposite  to  the  nervous 
wards  to  the  north,  across  the  roadway  which  leads  from  the  clinic  gate  to  the 
clinic  hall,  are  two  one- story  brick  structures  with  porticos  in  front.  They  are' 
each  60  feet  long  and  33  feet  wide,  and  are  used  as  maternity  wards. 

North  of  the  northern  end  of  the  northeastern  and  the  eastern  end  of  the  north- 
western main  building,  is  the  general  laundry  of  the  institution,  a  brick  building, 
one  story  high,  170  feet  long  and  24  feet  wide. 

A  short  distance  north  of  this  laundry  and,  therefore,  northwest  of  the  northern 
extremity  of  the  northeastern  building,  are  the  two  pathological  buildings,  the 


HISTORICAL  MEMORANDA  OF  THE  PHILADELPHIA  ALMSHOUSE.    101 

laboratory  and  the  museum.  The  most  eastern  of  them  is  a  two-story  brick  struct- 
ure 40  feet  long  and  20  feet  wide,  the  first  floor  of  which  is  used  as  a  dead-house 
and  post-mortem  room,  and  the  second  by  pathological  and  bacteriological  labora- 
tories. Adjoining  thi<  building  to  the  west  is  the  pathological  museum,  just  com- 
pleted. 40  feet  long  40  feet  wide,  and  30  feet  high.  Northwest  of  these  path  >L  igical 
buildings,  but  separated  from  them  by  a  high  fence,  is  a  small  "  Pest  House.'-'  or 
hospital  for  contagions  diseases. 


ADDITIONS  AND  IMPROVEMENTS. 

When  the  new  board  of  guardians  came  into  power  in  1859, 
Mr.  Mahlon  H.  Dickinson  was  placed  on  the  committee  on  manu- 
factures. At  this  time  the  manufacturing  department  was  in  bad 
condition,  the  goods  made  scarcely  equalling  the  cost  of  material. 
The  building  used  was  a  one-story  wooden  structure  not  fit  to  be 
used  by  old  and  infirm  paupers. 

Mr.  Dickinson  succeeded  in  getting  an  appropriation  of  $5,000  from  city  councils 
for  a  new  building  which  was  erected  in  1860.  The  stone  was  taken  from  an 
abandoned  quarry  on  the  grounds,  and  the  work  done  by  inmates  of  the  insti- 
tution. The  gravel  for  the  plaster  was  al-o  obtained  on  the  premises.  In  this 
way  a  building,  worth  $8,000  or  $10,000,  was  erected  at  a  cost  of  about  $5,000. 
After  it  was  completed,  the  house  was  searched  for  mechanics,  and  carpenters, 
painters,  tinsmiths,  blacksmiths,  tailors,  weavers,  etc.,  were  found  and  put  to 
work,  these  men  sometimes  being  given  a  little  extra  tobacco,  or  some  special 
privilege,  as  an  inducement  to  do  well.  Old  hand-looms  were  repaired  by 
inmates,  and  after  a  time  blankets  were  made  for  the  house.  The  value  of  the 
goods  thus  manufactured  in  the  institution,  after  a  few  years,  amounted  to 
many  thousand  dollars.  This  manufacturing  department  has  continued  to  be  an 
important  department  of  the  almshouse,  as  a  study  of  the  report-  of  the  institution 
will  show. 

Councils,  in  1870,  appropriated  $70,000,  and  two  new  wings,  with  modern 
improvements,  were  added  to  the  insane  department,  furnishing  room  for  180 
additional  patient-.  It  was  largely  through  the  efforts  of  Mr.  George  L.  Harrison 
that  this  work  was  accomplished  -  only  one  of  a  multitude  of  good  deeds  done  by 
him  for  the  insane  and  defective  classes.  For  years,  while  a  member  of  the  board 
of  public  charities,  Mr.  Harrison  devoted  much  time  and  attention  to  the  insane 
department  of  the  Philadelphia  Hospital,  to  which  Dr.  Richardson  in  his  annual 
reports  gratefully  refers. 

In  1874.  a  committee  of  councils  rerjorted  in  favor  of  the  erection  of  a  series  of 
temporary  wooden  pavilions  for  the  medical,  surgical,  and  insane  departments. 
These  were  built  in  1875 — those  for  the  insane  in  the  space  west  of  the  dej  art- 
ment  :  the  others,  in  the  yard  east  of  the  northeast  building  of  the  quadrangle. 
The  board  of  public  charities  called  attention  to  the  danger  of  fire  from  these 
building-!  in  1879,  and  in  1880  the  pavilions  for  the  insane  were  removed.  The 
other  pavilions  wee  used  for  varions  medical  and  surgical  purposes,  until  the 
wards  for  nervous  diseases  were  started  in  them  in  1877.     Thev  continued  to  be 


102    HISTORICAL  MEMORANDA  OF  THE  PHILADELPHIA  ALMSHOUSE. 

used  as  nervous  wards  until  they  were  demolished  one  after  the  other  ;  the  first 
in  1884,  the  last  not  until  1888.  The  maternity  building  and  the  new  brick  pavil- 
ions now  occupy  most  of  the  space  where  they  formerly  stood.  Long  before  they 
were  destroyed  they  became  ricketty,  vermin  infected,  unsightly  structures. 

We  will  rapidly  glance  at  the  most  important  of  the  many 
recent  improvements  in  the  almshouse  and  hospital.  Such  im- 
provements are  by  no  means  confined  to  the  erection  of  separate 
buildings  or  the  enlargement  of  others.  Some  of  the  most  valuable 
are  with  reference  to  lighting,  ventilation,  drainage,  machinery, 
paving,  painting,  plastering,  and  similar  important  work. 

Of  all  the  inventions  of  the  enemies  of  the  sick  and  poor,  one  of  the  most  atro- 
cious was  the  series  of  blind  rooms  or  cul  de  sacs,  known  about  Blockley  as  the 
"cubbies."  These  were  a  series  of  small  rooms  constructed  of  solid  masonry 
against  the  blind  partition  walls  of  the  larger  rooms  or  wards.  They  were  in  two 
rows,  one  a  gallery  above  the  other.  The  only  opening  in  them  was  a  low 
arched  door  in  the  masonry.  In  each  of  these  was  placed  a  bed  ;  and  more  than 
once  we  have  heard  Dr.  Ludlow,  familiar  with  the  details  of  Blockley  history, 
tell  how  they  were  regarded  by  their  designer  as  an  achievement  for  the  poor  of 
which  Philadelphia  might  be  justly  proud,  as  they  gave  to  each  shipwrecked 
pauper  his  own  bedroom.  Strangely  enough,  many  a  poor  Blockley  outcast  cher- 
ished his  unlighted,  unventilated  cave  with  deep  affection,  and  resented  with 
execrations  its  destruction. 

Active  attention  was  directed  to  the  removal  of  the  cells  and  cubbies,  already 
described,  as  early  as  January  31,  1870,  at  which  time  a  letter  was  received  from 
the  outward  committee  showing  the  necessity  of  alteiations  for  additional  wards, 
enlargement  of  the  female  bathing  tank,  and  above  all,  the  removal  of  the  cells  and 
cubbies.  Not  much,  however,  was  done  in  this  direction  until  four  or  five  years 
ago.  In  the  report  of  the  superintendent  for  1886,  he  refers  to  the  removal  of  some 
of  the  cubbies  from  the  old  men's  outward  ;  in  1887,  this  work  was  continued  with 
activity,  as  also  in  1888,  when  the  men's  and  women's  outwards  were  largely 
relieved  of  these  pest-holes. 

In  1884,  the  southern  end  of  the  southeastern  main  building,  formerly  used  as  a 
nursery  and  children's  asylum,  was  re-plastered  and  thoroughly  fitted  up  as  a  home 
for  the  nurses  of  the  hospital,  and  the  old  school  room  in  the  same  building  as  a 
drug  store.  The  former  drug  store  was  on  the  south  side  of  the  corridor,  which 
led  from  the  clinic  hall  through  the  centre  of  the  south-eastern  building. 

After  the  removal  of  the  women's  nervous  wards  to  the  lower  floor  of  the  women's 
outwards,  the  maternity  wards  were  erected.  The  first  reference  to  them  is  to  be 
found  in  the  minutes  of  the  board  of  guardians,  May  2,  1884,  when  Dr.  Thomas 
Biddle  moved  that  a  maternity  ward  should  be  erected  on  the  space  now  occupied 
by  the  female  nervous  pavilion.  On  June  23,  1884,  the  house  committee  reported 
this  ward  well  under  way.  It  was  completed  during  the  year,  and  opened  January 
1,  1885. 

In  1886,  a  new  brick  pavilion  for  the  men's  nervous  wards  was  erected  in  the 
yard  east  of  the  southeastern  main  buildings,  parallel  with  it,  and  between  it  and 
the  wooden  pavilions.  In  1887,  another  one-story  brick  building  was  erected  in 
the  western  side  of  the  same  yard,  but  at  an  angle  with  the  first  pavilion  and  the 


HISTORICAL  MEMORANDA  OF  THE  PHILADELPHIA  ALMSHOUSE.    103 

main  building.  This  was  the  first  of  a  series  of  pavilions  which  had  been  provided 
for  by  councils  and  the  department  of  charities  and  correction.  During  the  year 
1888,  the  last  of  the  rickety  and  unwholesome  wooden  pavilions  were  removed  and 
two  additional  two-story  brick  buildings  substituted  for  them.  In  1889,  an  addi- 
tional story  was  put  on  the  pavilion  erected  in  1887. 

In  1886,  the  accumulated  income  of  the  Mary  Shields'  legacy 
was  applied  to  the  erection  of  a  new  kitchen-building,  with  com- 
plete apparatus  for  cooking  of  the  best  character.  This  was 
nearly  finished  at  the  time  of  the  disastrous  fire  on  the  night  of 
February  12, 1885,  after  which  the  work  was  rapidly  pushed  and 
completed,  furnishing  much  needed  accommodation,  the  old 
kitchen  having  been  destroyed.  A  kitchen  was  also  built  and 
furnished  for  the  general  hospital  in  1886,  and  during  the  past 
year,  part  of  the  cost  of  a  third  kitchen  has  been  paid. 

In  1887,  the  nurses'  apartments  and  the  quarters  of  the  resident  physicians  were 
thoroughly  renovated.  The  general  laundry  was  enlarged,  new  machinery  intro- 
duced, a  drying-room  for  the  laundry  of  the  insane  department  was  built,  the  outer 
walls  of  the  buildings  were  rough-coated,  the  outside  woodwork  was  repainted, 
balconies  to  the  fire-escapes  were  completed,  and  pipes  were  laid  lor  increased  water 
supply  to  the  institution. 

In  1888,  additional  fire  escapes  were  erected  Much  paving  in  the  hospital 
grounds  was  completed,  the  asphalt  pavements  which  are  now  found  in  the  streets 
of  the  quadrangle  being  first  introduced.  An  important  improvement  during  this 
year  was  the  building  of  a  trunk  450  feet  long,  connected  with  the  sewer  of  the 
insane  department,  to  carry  the  drainage  beyond  low  water  mark  in  the  Schuyl- 
kill. This  was  built  and  the  sewer  cleansed  of  its  contents.  This  sewer  had  not 
been  cleansed  for  a  period  of  fifty  years,  and  from  it  were  taken  one  hundred  and 
forty-two  cart  loads  of  material. 

During  the  discussion  arising  out  of  the  great  fire  which  partially  destroyed  the 
insane  department  in  February,  1885,  it  was  made  apparent  that  one  of  Philadel- 
phia's greatest  needs  was  a  State  hospital  for  the  insane,  to  be  devoted  entirely  to 
the  reception  of  patients  belonging  to  this  county,  the  city  maintaining  a  small 
department  at  Blockley  in  connection  with  the  general  hospital  for  the  reception  of 
acute  patients,  or  the  temporary  detention  of  doubtful  cases.  It  was,  however, 
finally  decided  to  rebuild  the  burned  structures  on  the  old  site.  This  was  done 
the  first  half  of  1887,  but  various  alterations  and  changes  in  the  old  plan  were 
made.  The  main  building  which  formed  the  southwestern  side  of  the  original 
quadrangle  was  the  one  most  completely  destroyed  by  the  fire.  This  was  rebuilt 
and  the  northern  wing  repaved.  In  rebuilding  it  the  centre  was  carried  to  three 
stories,  but  the  extensions  on  each  side  from  the  centre  were  built  to  only  two. 
Open  ways  were  also  left  between  this  building  and  the  wings.  Fire-escapes  were 
added  to  the  structures  in  1886. 

In  1889,  the  removal  of  the  cobble  stone  pavements  of  the  quadrangle,  and  the 
substitution  for  them  of  the  cement  pavements,  was  continued.  New  and  greatly 
improved  water  closets  were  erected  in  the  outwards,  the  nursery,  the  obstetrical 
ward,  and   in  the  men's  medical  and  venereal  wards — a  work  of  vital  import- 


104    HISTOEICAL  MEMORANDA  OP  THE  PHILADELPHIA  ALMSHOUSE. 

ance  to  the  health  of  the  wards.  During  this  year  city  councils  appropriated 
money  for  the  electric  lighting  of  not  only  the  buildings  but  the  surrounding 
grounds  ;  the  appropriation  included  an  item  for  an  electrical  plant  at  the  institu- 
tion. This  work  was  placed  under  the  supervision  of  the  electrical  bureau,  and 
during  1890  was  begun,  so  that  now  a  portion  of  the  institution  and  grounds  is 
illuminated  by  electricity.  The  wooden  door  frames  of  the  insane  departments 
were  also  removed  during  this  year,  and  replaced  by  others  made  of  iron. 

Connected  with  the  hospital  had  long  been  a  ward  known  as  the  drunkard's  ward, 
or  as  usually  designated,  "the  drunk  ward."  This  was  in  the  first  instance  set 
aside  for  the  reception  of  those  suffering  from  mania-a-potu,  or  for  such  cases  as 
were  indicated  by  the  attending  physician  or  by  the  medical  board.  It  was  also  a 
custom  to  place  in  this  ward  patients  who  were  temporarily  disturbing  or  dangerous, 
or  whose  sanity  was  doubtful,  sometimes  detaining  them  here  until  an  examina- 
tion was  made  with  a  view  of  transferring  them  to  the  insane  department.  In 
1880,  this  ward  was  changed  into  one  which  is  now  known  as  the  detention  ward, 
and  since  then  doubtful  cases  in  the  general  hospital,  and  similar  cases  received 
from  the  outside  through  the  police  department,  have  been  detained  in  this  ward 
until  thorough  examination  into  their  mental  condition  has  been  made. 

In  1890,  city  councils  made  an  appropriation  from  the  almshouse  property 
fund  to  the  department  of  charities  and  correction  for  the  erection  of  addi- 
tional buildings  on  the  grounds  of  the  almshouse.  These  buildings,  a  portion  of 
which  are  now  under  way,  are  to  be  independent  wings  from  the  buildings  now 
existing  on  these  grounds.  A  competent  architect  was  authorized  to  prepare  plans 
for  them,  and  these  plans  were  drawn  and  eventually  approved  by  the  department 
of  charities  and  correction  and  by  the  mayor. 

The  department  had  a  survey  made  of  a  portion  of  the  almshouse  grounds,  and 
found  two  available  areas  for  building  purposes,  one  on  the  west  between  the  wings 
of  the  insane  department  and  the  west  end  of  the  property,  a  vacant  space  635  feet 
in  length,  362  feet  wide  in  the  centre,  and  202  feet  wide  at  each  end  ;  on  this  space 
it  was  recommended  to  extend  the  buildings  of  the  much  overcrowded  insane 
wards.  The  real  capacity  of.  these  wards  is  600  ;  the  population  when  the  recom- 
mendation was  made,  883  ;  and  it  was  expected  soon  after  to  have  returned  from 
Danville  74  insane  patients,  sent  there  after  the  fire,  making  an  excess  of  357  beyond 
the  real  capacity. 

The  department  also  reported  that  on  the  north  end  of  the  property  was  a  plot 
irregular  in  shape,  118  feet  wide  and  927  feet  long,  its  greatest  length  being  1021 
feet,  on  which  it  was  suggested  to  erect  ten  two  story  pavilions,  costing  about 
$5,000  each,  which  would  be  capable  of  accommodating  100  patients  each,  and 
would  be  better  suited  for  hospital  purposes  than  the  present  buildings.  These 
additions  were  earnestly  recommended,  and  it  was  believed  if  this  was  done  the 
complaint  of  overcrowding,  lack  of  accommodation,  and  their  attendant  evils  would 
be  removed,  and  the  department  would  possess  the  required  space  and  facilities  to 
take*care  of  its  population  for  many  future  years. 

Much  work  for  the  improvement  of  the  almshouse  and  its  hos- 
pital department  is  expected  to  be  done  during  the  year  1891. 
The  additional  wings  for  both  male  and  female  insane  patients  . 
will  probably  be  completed.     Directly  west  of  the  centre  of  the 


HISTORICAL  MEMORANDA  OF  THE  PHILADELPHIA  ALMSHOUSE.    105 

main  building  is  to  be  built  a  refectory,  or  consolidated  dining- 
room,  208  feet  long  and  50  feet  wide,  of  a  general  height  of  one 
story,  and  45  feet  high  to  the  top  of  the  dome.  This  building  is 
to  be  divided  into  two  apartments,  for  male  and  female  patients 
respectively,  and  will  have  a  seating  capacity  for  one  thousand. 
It  is  to  communicate  with  the  wards  by  an  underground  passage 
lighted  with  electricity.  Attached  will  be  a  two-story  brick  build- 
ing, the  basement  -to  be  for  the  kitchen  ;  the  first  floor  to  be  the 
sewing-room ;  and  the  second  floor  for  the  sleeping  apartments 
for  male  and  female  attendants.  It  is  also  proposed  during  the 
ye&x  1891  to  construct  from  the  Mary  Shields'  legacy,  a  steam 
elevator  in  the  centre  of  the  hospital  building,  capable  of  holding 
a  cot  to  enable  patients  to  be  better  transferred  from  floor  to  floor. 
An  additional  electric  light  plant  is  also  to  be  established,  with  a 
dynamo  to  light  incandescent  lamps  in  all  the  hallways  of  the 
institution,  the  superintendent's  office  and  the  private  apartments. 

At  various  times,  and  particularly  during  the  last  five  years, 
efforts  have  been'  made  to  remove  the  pauper  element  of  the 
almshouse  to  some  other  place  than  its  present  location.  On 
January  22,  1883,  for  instance,  a  request  was  sent  by  the  med- 
ical staff  to  the  board  of  guardians  asking  for  this  removal ;  also 
on  November  24,  1884,  a  communication  was  made  to  the  board 
concerning  the  desirability  of  removing  the  almshouse  to  the 
grounds  of  the  house  of  correction.  At  a  meeting  of  the  board 
July  12,  1884,  a  committee  of  three  was  appointed  to  confer  with 
councils  as  to  the  removal  of  the  pauper  element  and  the  erection 
of  a  new  almshouse. 

Shortly  after  the  great  fire  which  resulted  in  the  destruction  of 
a  large  portion  of  the  insane  department,  these  efforts  were 
renewed,  and  a  committee  was  appointed  by  the  medical  board 
to  circulate  a  petition  for  this  removal,  which  was  signed  by  a 
large  number  of  physicians.  In  the  report  of  the  board  of  chari- 
ties and  correction  for  1887,  Dr.  J.  W.  White  again  urged  this 
removal  and  the  use  of  the  entire  space  at  Blockley  for  the  sick. 
So  far,  however,  this  step  has  not  been  taken. 

The  main  reasons  advanced  for  the  separation  of  the  almshouse 
and  hospital  have  been  the  relief  thereby  of  the  great  overcrowd- 
ing, the  removal  from  the  sick  poor  of  the  stigma  which  attaches 
to  the  name  almshouse,  and  the  increased  opportunities  which 
would  be  afforded  to  improve  and  perfect  both  the  hospital  and 
the  almshouse  service. 


106    HISTORICAL  MEMORANDA  OF  THE  PHILADELPHIA  ALMSHOUSE. 

The  mayor,  and  the  present  board  of  directors,  have  not 
favored  this  separation  for  reasons  given  in  the  annual  mes- 
sage of  the  mayor  for  1889.  The  chief  of  these  reasons 
are,  that  it  will  be  necessary  to  build  an  additional  hospital  in 
connection  with  the  new  buildings  to  accommodate  the  cases  of 
sickness  constantly  occurring  in  the  institution ;  that  the  removal 
of  the  almshouse  to  Holmesburg  would  greatly  add  to  the  cost  of 
conducting  two  institutions  separated  by  nearly  ten  miles ;  that 
for  reasons  of  convenience  and  expense,  the  almshouse  should  be 
near  to  the  city ;  that  nearly  all  the  inmates  of  the  alms- 
house are  proper  subjects  for  hospital  care ;  that  the  separation 
would  cause  not  only  a  large  expenditure  of  money  for  the  erec- 
tion of  a  new  building,  but  would  make  necessary  large  additional 
fixed  expenditures  for  management,  with  inconvenience  and 
injury  to  the  patients  required  to  be  moved  from  one  to  the  other. 


EPIDEMICS  IN  THE   PHILADELPHIA  HOSPITAL 
FROM  1862  TO  1890. 


By  ROLAND  G.  CURTIN,  M.D. 


A  continuation  of  the  account  of  the  important  erjidemics  which 
have  visited  the  Philadelphia  Hospital  since  1862,  the  date 
to  which  they  were  brought  by  Dr.  Agnew  in  his  history  of 
the  hospital,  is  here  attempted.  The  following  are  the  most  im- 
portant epidemics  since  that  date  arranged  in  chronological  order. 

Typhus  fever.  1864-5,  1867,  and  1881-2-3  :  cholera,  1866  ;  cerebrospinal  menin- 
gitis. 1S66-7  ;  malignant  measles,  1868,  1882,  1884,  1887  ;  relapsing  fever,  1869- 
70  ;  typhoid  fever.  1876  :  puerperal  fever,  1876-7-8,  1881,  and  1883  ;  influenza, 
1889-90. 

The  statistics  of  some  of  these  epidemics  are  exceedingly  meagre 
owing  to  the  absence  of  some  of  the  older  record  books. 

Typhus  Fever. — During  the  last  year  of  the  war  of  the  rebellion 
and  the  following  year,  an  epidemic  of  typhus  fever  occurred. 
This  was  attributed  to  infection  from  the  soldiers  who  were  sent 
to  the  northern  military  hospitals.  The  medical  history  of  the 
war  states  that  2,501  cases  of  typhus  occurred  among  the  troops 
of  the  L  nited  States  army,  and  of  these,  850  cases  proved  fatal. 
During  186-1  and  1865,  numerous  cases  were  treated  in  the  Phila- 
delphia Hospital,  though  it  is  impossible  to  state  the  exact  num- 
ber. In  the  women's  medical  ward  alone,  154  were  treated,  of 
which  number  27  died.  Probably  in  all  700  or  800  cases  were 
treated  durng  these  years  (1864-5).  It  was  during  this  epidemic 
that  Dr.  J.  P.  Tutt,  at  that  time  visiting  physician,  lost  his  life. 
Having  made  a  post-mortem  on  a  malignant  case,  a  few  days  sub- 
sequently he  took  the  fever  and  died  in  less  than  a  week,  after 
great  suffering. 

During  the  summer  and  autumn  of  1867,  about  the  time  when 
the   epidemic   of    cerebro-spinal    meningitis    subsided,  another 

(107) 


108  EPIDEMICS  IN  THE  PHILADELPHIA  HOSPITAL. 

virulent  epidemic  of  typhus  appeared,  and  300  cases  were 
treated.  Many  of  these  originated  in  the  old  cubbies  in  the  out- 
wards, and  in  the  surgical  garret,  among  the  old  men  having  leg- 
ulcers  and  other  chronic  affections.  The  fatality  was  great  owing 
to  the  type  of  the  disease,  the  age;  former  habits,  and  generally 
broken-down  condition  of  the  patients.  Again  in  1881,  typhus 
fever  appeared,  having  been  introduced  from  Europe  by  emi- 
grants. In  the  Philadelphia  Hospital  during  the  years  1881, 
1882  and  1883,  in  the  men's  and  women's  medical  wards,  69  cases 
were  treated  and  27  of  these  died.    « 

Asiatic  Cholera. — During  the  summer  and  fall  of  1866,  while  I 
was  resident  in  the  insane  department,  about  150  cases  of  cholera 
were  treated  in  the  old  temporary  smallpox  hospital,  which  had 
been  used  for  smallpox  and  other  infectious  and  contagious  diseases 
before  the  municipal  hospital  was  built.  The  board  of  guardians 
at  their  stated  meeting  held  May  19, 1862,  appointed  a  committee 
of  three  to  erect  a  building  for  smallpox  patients.  It  was  situ- 
ated below  the  southern  end  of  the  eastern  wing  of  the  insane 
department,  in  the  field  near  the  West  Chester  railroad.  I  well 
remember  the  old  pine  barracks,  with  its  unplaned  boards,  with 
cracks  of  sufficient  width  to  allow  the  inmates  to  look  out  from 
their  beds  to  view  a  pile  of  coffins  placed  outside,  ready  to  receive 
the  next  victims.  Eighty-two  deaths  occurred  in  this  building. 
The  old  residents  of  the  insane  department  furnished  a  large 
number  of  the  cases  affected,  and  among  them  the  disease  was 
particularly  fatal.  This  was,  I  believe,  the  fourth  epidemic  of  this 
disease  which  visited  the  hospital.  The  other  visitations  were  in 
1832,  1849  and  1854,  as  will  be  observed  in  Dr.  Agnew's  history. 

At  the  stated  meeting  of  the  board  of  guardians  held  March  19,  1866,  as  appears 
from  the  minutes,  a  communication  was  read  from  Dr.  Tutt  in  regard  to  certain 
rules  and  regulations  necessary  in  the  event  of  the  appearing  of  the  cholera,  which 
was  referred  to  the  committee  on  hospital  and  diet.  At  the  meeting  of  May  28th, 
the  hospital  committee  presented  a  communication  from  the  medical  board  signed 
by  Edward  L.  Duer.  secretary,  in  which  it  was  stated  that  at  a  special  meeting  of 
the  medical  board,  the  following  preamble  and  resolutions  were  adopted  : — 

"  Whereas,  it  is  the  general  opinion  of  the  medical  profession  that  Asiatic  cholera 
is  propagated  from  the  sick  to  the  well,  and  that  isolation  of  the  affected  is  of  the 
greatest  importance  in  the  arrest  of  disease ;  therefore, 

•  'Besolved,  that  the  hospital  committee  be  requested  to  procure  suitable  hospital 
tents  to  be  immediately  erected  on  an  open  field,  on  the  very  first  outbreak  of  the 
disease,  and  that  the  patients  be  immediately  removed  thereto,  as  soon  as  they  are 
seized  with  the  affection." 


EPIDEMICS  IN  THE  PHILADELPHIA  HOSPITAL.  109 

In  the  Annual  Statement  of  the  board  of  guardians  for  the  year 
ending  December  31, 1866,  is  the  following  report  by  a  committee 
of  the  board  : — 

• '  Your  coraraittee  beg  leave  to  call  your  attention  to  the  breaking  out  of  the 
cholera  at  the  almshouse  the  present  year,  and  to  the  apparent  effect,  under  the 
blessing  of  a  kind  Providence,  produced  by  thorough  ventilation  from  the  floor,  in 
its  prevention  and  final  disappearance  from  the  institution.  The  disease  first 
attacked  four  patients  and  a  nurse  in  one  of  the  wards  of  the  women's  hospital, 
which  ward,  upon  close  examination,  was  found  to  be  imperfectly  ventilated.  This 
was  at  once  remedied,  after  which  there  were  no  more  cases  in  the  hospital. 

''In  the  insane  department  for  females  the  cholera  occurred  in  several  of  the 
wards.  These  were  ventilated  by  the  old  plan — from  the  ceiling,  or  by  Avindows 
and  doors.  The  ventilation  in  this  department  was  not  yet  perfected,  but  on  the 
appearance  of  the  disease  strong  efforts  were  made  to  push  it  forward,  and  it  is  a 
remarkable  fact,  that  as  soon  as  thorough  ventilation  from  the  floor  was  established, 
the  cholera  disappeared  from  the  institution.  It  may  be  proper  here  to  remark 
that  heat  was  introduced  into  the  wards  about  two  hours  daily  during  the  preval- 
ence of  the  disease  ;  and  it  is  also  worthy  of  note  that  in  no  part  of  the  almshouse, 
although  crowded,  was  there  any  cholera  where  ventilation  from  the  floor  was  thor- 
oughly established  ;  and  we  would  further  state,  where  it  has  been  fully  perfected. 
no  case  of  fever  or  dysentery,  and  a  very  few  of  erysipelas  or  gangrene,  have  origin- 
ated in  the  hospital,  or  in  any  part  of  the  house,  and  those  patients  brought  from 
the  city  with  those  diseases  mostly  soon  recovered,  and  the  health  of  the  inmates  is 
at  this  time  excellent. ' ' 

Cerebro-Spinal  Meningitis. — In  the  fall  of  1866,  and  the  early 
part  of  1867,  an  extensive  outbreak  of  epidemic  cerebro-spinal 
meningitis  occurred.  About  200  cases  were  treated  in  the 
hospital.  The  cases  early  in  the  epidemic  were  largely  fatal, 
but  later  the  mortality  was  much  diminished.  Dr.  Alfred  Stille,1 
then  one  of  the  visiting  physicians,  published  a  valuable  mono- 
graph on  this  disease.  Dr.  W.  H.  H.  Githens,2  a  member  of 
the  resident  staff,  wrote  an  instructive  paper  for  the  American 
Journal  of  the  Medical  Sciences,  giving  data  of  98  cases.  Dr. 
Stille's  monograph  was  dedicated  to  the  clinical  class  of  the  Phila- 
delphia Hospital  for  1866-7,  and  in  his  introductory  he  speaks  as 
follows : — 

"As  the  epidemic  meningitis,  which  has  ravaged  the  United  States  for  the  last 
ten  or  eleven  years,  appears  to  be  approaching  the  termination  of  its  career,  the 
present  seems  to  be  a  fitting  occasion  for  reviewing  its  course  and  studying  its 
analogies  with  European  and  other  American  epidemics  of  the  same  disease,  and 

1  Epidemic  meningitis,  or  Cerebro-spinal  meningitis,  by  Alfred  Stille,  M.D.  Philadelphia, 
Lindsay  &  Blakiston,  1867. 

•2  American  Jour.  Med.  Sci.,  July,  1867.  , 


110  EPIDEMICS  IN  THE  PHILADELPHIA  HOSPITAL. 

for  guarding,  if  possible,  future  generations  of  physicians  against  misconceptions 
and  mistakes,  the  confusion  of  ideas,  and  the  still  greater  confusion  of  terms,  which 
even  now  have  not  altogether  censed  to  have  currency  among  professional  teachers 
aud  writers.  We  have  been  the  more  strongly  moved  to  attempt  placing  the  sub- 
ject in  a  clear  light,  by  the  practical  acquaintance  with  it,  which  we  acquired 
during  the  first  quarter  of  the  present  year,  while  studying  about  120  cases  of  the 
disease  in  the  Philadelphia  Hospital.  Nearly  100  of  them  form  the  subject  of  a 
very  valuable  report  contributed  by  Dr.  Githens  to  the  'American  Journal  of  the 
Medical  Sciences.'  In  the  corresponding  term  of  the  previous  year  we  witnessed  a 
still  more  extensive  and  fatal  epidemic  of  typhus  fever  in  the  same  institution, 
where,  also,  thirty  years  before,  we  had  become  familiar  with  that  fever  as  a  resi- 
dent physician  of  the  hospital  during  the  great  epidemic,  the  history  of  which  is 
so  honorably  associated  with  the  names  of  Gerhard  and  Pennock.  Such  oppor- 
tunities were  peculiarly  fitted  to  reveal  the  grounds  of  the  common  error  of  con- 
founding epidemic  meningitis  and  typhus  fever,  into  which  physicians  acquainted 
with  only  one  of  these  affections  have  been  prone  to  fall,  as  well  as  to  illustrate  the 
surprising  variety  of  morbid  phenomena  which  the  former  exhibits  by  virtue  of  its 
double  character  as  a  blood  disease,  and  an  inflammation  of  the  cerebro-spinal 
membranes." 

Malignant  Measles. — In  1868,  during  the  months  of  April,  May 
and  June,  an  epidemic  of  "black  measles"  occurred,  of  which 
Dr.  DeForest  Willard,  then  a  resident  physician,  has  kindly  fur- 
nished me  with  some  notes.  The  first  cases  were  mild,  but  in  a 
few  clays  the  extreme  malignancy  of  the  disease  became  so  great 
that  the  patients  sometimes  died  before  treatment  could  be  fairly 
instituted,  and  frequently  within  twenty -four  hours  after  the 
appearance  of  the  rash.  Pulmonary  complications  existed  in 
nearly  all  the  cases.  The  number  of  deaths  was  about  80.  In 
the  foundling  ward,  15  of  the  16  inmates  died  within  four  days. 
In  1882,  many  cases  of  measles  also  occurred ;  in  this  epidemic 
it  is  stated  that  in  the  foundling  ward  13  out  of  11  children  died. 
In  January  and  February,  1884,  malignant  measles  again  invaded 
the  children's  wards.  Dr.  E.  P.  Bernardy,  then  a  visiting  obstet- 
rician, has  given  me  the  following  facts  in  regard  to  this  out- 
break : 

Under  his  care  were  73  cases,  of  which  21  died  during  the  disease  and  convales- 
cence, 2  of  this  number  dying  two  weeks  later  of  pneumonia.  The  cases  at  the 
commencement  of  the  epidemic  were  of  the  malignant  form  ;  later  they  were  of  a 
milder  type.     Most  of  the  fatal  cases  were  complicated  with  pneumonia. 

In  1887,  from  May  to  September,  16  cases  were  reported. 

Relapsing  Fever. — Some  cases  of  this  disease  found  their  way 
into  the  Philadelphia  Hospital  in  1844,  as  also  at  its  second  visi- 
tation in  1848  to  1850,  but  in  1869  and  1870,  between  200  and 


EPIDEMICS  IN  THE  PHILADELPHIA  HOSPITAL.  Ill 

300  cases  were  treated.  Upon  each  visitation  the  disease  was 
introduced  from  Europe.  Drs.  William  Pepper  and  Edward 
Rhoads,  visiting  physicians,  studied  over  200  cases,  and  the 
results  of  their  labors  were  later  embodied  in  a  paper  by  Dr. 
Pepper.1  Dr.  Rhoads  contracted  the  fever,  and  so  damaged  a  pre- 
viously diseased  heart,  that  he  never  recovered  his  strength.  Dr. 
John  S.  Parry,  one  of  the  obstetricians  of  the  hospital,  also  wrote 
an  article2  on  the  subject,  giving  his  conclusions  from  the  study 
of  a  large  number  of  cases.  Eleven  hundred  and  seventy-six 
cases  were  reported  in  Philadelphia. 

At  the  stated  meeting  of  the  board  of  guardians,  March  28,  1870,  a  resolution 
was  offered  that  the  smallpox  buildings  be  immediately  fitted  up  for  the  use  of 
relapsing  fever  patients,  and  this  was  referred  to  the  committee  on  hospitals.  At  the 
same  meeting  the  medical  board  was  requested  to  investigate  the  alarming  increase 
in  the  cases  of  lever  prevailing  in  the  hospital,  and  also  if  the  bathing  of  the 
inmates  once  a  week  could  have  any  possible  influence  on  the  same. 

At  the  meeting  of  xlpril  25,  1870,  a  committee  of  the  medical  board,  consisting  ot 
Drs.  A.  Stille,  E.  Rhoads,  J.  L.  Ludlow  and  W.  Pepper,  reported  to  the  hospital 
committee  of  the  board  of  guardians,  that  at  special  meeting  of  the  medical  board 
a  committee  was  appointed  to  examine  the  localities  for  the  erection  of  additional 
buildings  for  the  accommodation  of  acute  infectious  diseases,  and  make  report,  that 
having  examined  the  premises,  they  recommend  to  the  hospital  committee  that  a 
building  be  erected  immediately,  and  that  in  their  opinion  the  most  eligible  site  is 
in  the  space  between  the  west  wall  and  the  hospital  buildings. 

At  a  meeting  of  the  board  of  guardians  held  May  23,  1870,  a  request  was  made 
by  the  board  of  health  to  admit  relapsing  fever  patients  into  the  Philadelphia  Hos- 
pital as  the  municipal  hospital  was  full ;  accordingly  at  a  special  meeting  held 
May  31,  1870,  the  request  was  complied  with,  owing  to  the  exigencies  of  the  case, 
and  the  old  smallpox  hospital  building  was  offered  for  the  fever  patients. 

The  following  occurs  in  the  Annual  Statement  of  the  year  1870, 
in  the  report  of  John  H.  Parry,  secretary  of  the  medical  board  : 

"During  the  year  1870.  as  you  well  know,  the  hospital  has  been  taxed  to  its 
utmost  by  the  epidemic  of  relapsing  fever,  which  swept  over  the  eastern  part  of  the 
country.  In  March  or  April  last  the  first  case  was  admitted,  and  during  the  year 
458  persons  were  treated  for  the  affection. 


"The  mortality  of  all  the  cases — thirteen  and  three-fourths  per  cent. — was  high, 
and  the  excess  of  deaths  was  in  the  black  men's  medical  ward.  The  disparity 
between  this  and  the  death  rates  in  other  departments  is  very  striking,  and  particu- 
lar attention  is  called  to  the  fact  that  the  lowest  mortality  was  among  colored 
women.  The  number  of  cases  among  the  colored  men  was  just  double  that  among 
women,  while  the  mortality,  instead  of  being  twice,  was  sixteen  times  as  great." 

1  American  System  Pract.  Medicine,  Vol.  I,  p.  369. 
-  American  Jour.  Med.  Sciences,  Vol.  LX.     Oct.,  1870. 


112  EPIDEMICS  IN  THE  PHILADELPHIA  HOSPITAL. 

"In  regard  to  this  fact  I  received  the  following  communication  from  Drs.  Stille' 
and  Pepper  : — 

"  !  In  explanation  of  this  apparently  unaccountable  excess  of  mortality  among  the 
black  men,  various  circumstances  may  be  advanced.  In  the  first  place,  a  very  large 
proportion  of  the  patients  of  this  class  were  admitted  in  a  dying  state,  and  in  more 
than  one  case  death  actually  occurred  before  the  patient  could  be  placed  in  the  bed. 
In  very  few  instances,  indeed,  did  they  seek  admission  until  a  stage  of  the  disease 
had  been  reached  when  the  chances  for  successful  treatment  were  greatly  diminished. 
Again,  it  is  a  positive  fact  that  relapsing  fever,  as  occurring,  presented  a  degree  of 
gravity  (indicated  by  intense  jaundice,  passive  hemorrhages,  suppression  of  urine, 
etc)  not  met  with  in  any  other  class  of  patients.  We  must  call  attention  to  the 
fact  that  the  black  men's  medical  ward,  in  common  with  other  medical  wards,  and 
probably  to  even  a  greater  degree,  was  overcrowded  with  these  grave  cases,  and 
that  ample  space  and  most  free  ventilation  are  very  important  in  the  treatment  of 
all  zymotic  diseases. ' ' ' 

Typhoid  Fewer. — In  1876,  during  the  centennial  exhibition, 
typhoid  fever  was  rife  in  Philadelphia,  and  the  Philadelphia 
Hospital  had  many  cases,  but  far  less  than  might  have  been 
supposed,  as  the  disease  did  not  so  generally  affect  the  poor,  but 
those  in  better  circumstances,  who  did  not,  as  a  rule,  seek  the 
hospitals.     Over  50  cases,  however,  were  treated. 

Puerperal  Fever. — More  or  less  of  this  disease  has  been  present 
during  many  years. 

In  the  Annual  Statement  of  board  of  guardians  for  year  ending 
December  31,  1865,  appears  the  following  report,  by  Dr.  R.  M. 
Girvin,  recording  clerk  : — 

'•  During  the  last  quarter  of  the  year,  puerperal  peritonitis  made  its  appearance 
in  the  obstetrical  department,  threatening  to  be  epidemic  The  lying-in  ward  was 
immediately  vacated,  thoroughly  scrubbed  and  whitewashed,  and  disinfectants 
employed.  The  physician  in  charge  of  the  cases  attended  no  confinement  for  two 
Aveeks.  At  the  end  of  one  month  patients  were  again .  admitted  to  the  ward,  no 
return  of  the  disease  following.  The  prompt  hygienic  measures  adopted  seem  to 
have  arrested  the  spread  of  the  disease,  but  three  cases  occurring,  all  of  which  were 
attacked  within  seventy-two  hours  of  each  other. 

"  'Dr.  J.  S.  Parry  carefully  examined  such  records  as  could  be  obtained  of  this 
ward,  and  reports  as  follows  : — 

"  '  Cases  of  puerperal  peritonitis  occurred  hi  the  house  every  year  from  1841  to 
1858,  except  during  1844  and  1845.  In  January  and  February,  1849,  the  disease 
prevailed  as  an  epidemic,  at  the  end  of  which  time  the  ward  was  vacated  for  four 
weeks.  It  appeared  again  as  an  epidemic  about  the  middle  of  December,  1855. 
From  this  time  to  the  27th  of  February,  the  year  following,  twenty  cases  occurred, 
of  which  thirteen  died  and  seven  recovered. '  ' ' 

Dr.  W.  H.  Parish,  December  10, 1879,  before  the  Philadelphia 
county  medical  society,  read  a  paper  on  "  Puerperal  SepticEemia, 


EPIDEMICS  IN  THE  PHILADELPHIA  HOSPITAL.  113 

chiefly  as  observed  at  the  Philadelphia  Hospital,"1  from  which 
we  make  the  following  quotations,  which  cover  the  history  of 
about  ten  years. 

"  The  following  paper  is  based  chiefly  on  cases  occurring  in  the  Philadelphia  Hos- 
pital between  January  1,  1870,  and  December  1,  1879,  a  period  of  about  ten  years. 
They  are  arranged  in  the  books  of  the  white  obstetric  wards,  under  the  headings  of 
puerperal  fever,  septicaemia,  pyaemia,  general  peritonitis,  pelvic  peritonitis,  pelvic 
cellulitis,  metritis,  phlegmasia  dolens,  and  erysipelas.  The  sum  total  of  these  cases 
is  181,  of  which  there  have  been  88  cases  of  puerperal  fever,  8  cases  of  septicaemia, 
2  of  pyaemia,  35  of  general  rjeritonitis,  5  of  pelvic  peritonitis,  28  of  pelvic  cellulitis, 
6  of  metritis,  6  of  phlegmasia  dolens,  and  3  of  erysipelas.  I  have  studied  all  recorded 
cases  of  these  diseases,  because  I  believe  that  nearly  all  such  conditions  occurring  in 
lying-in  women,  either  originate  in  septicaemia,  or  are  modified  in  some  part  of  their 
progress  by  septic  influences. ' ' 

"The  record  shows  that  in  January,  February  and  March  of  1874,  pelvic  cellulitis 
and  pelvic  peritonitis  were  of  unusual  frequency,  12  cases  of  the  former  and  5  of  the 
latter  being  so  registered  on  the  ward  books,  and  a  number  of  milder  cases  were  not 
recorded. ' ' 

"The  most  serious  epidemic  occurred  during  March,  April  and  May  of  1877. 
During  these  months  there  occured  35  cases  with  the  recorded  diagnosis  of  puerperal 
fever.  Most  of  them  were  successive  cases  of  delivery,  and  in  not  one  of  them  is 
there  recorded  an  instance  of  interference  or  of  abnormality  during  labor.  The 
poison  in  these  cases  was  transferred  in  various  ways  from  patient  to  patient.  They 
were  all  normal  deliveries,  but  were  preceded  in  the  wards  by  cases  of  erysipelas, 
and  by  one  case  of  fatal  traumatic  peritonitis,  the  result  of  dystocia.  This  epidemic 
corresponded  in  its  general  manifestations  with  endemics  of  so-called  puerperal  fever 
seen  by  various  practitioners  in  rrractice,  and  often  noticed  in  lying-in  hospitals  ever 
since  the  establishment  of  such  institutions. ' ' 

The  following  extract  from  a  report  made  to  the  board  of  guar- 
dians April  26,  1886,  is  of  great  interest  in  connection  with  the 
subject  of  the  mortality  in  the  obstetrical  wards,  both  at  the  time 
of  epidemics  or  endemics,  and  at  other  periods.  It  also  shows  in 
a  striking  manner  the  great  good  accomplished  by  the  training- 
school  for  nurses. 

"Drs.  W,  H.  Parish  and  Theophilus  Parvin,  of  the  obstetrical  staff,  submit  the 
following  summary,  giving  the  total  inmates,  women  confined,  deaths  of  mothers, 
deaths  of  children,  total  deaths,  percentage,  of  total  mortality,  and  mortality  of 
mothers,  from  January  1,  1875  to  April  1,  1886. 

"  It  will  be  seen  that  this  summary  does  not  tally  with  the  'summaries'  in  the 
published  Annual  Statements  for  most  of  the  years  referred  to.  By  reason  of  strik- 
ing errors  in  the  method  of  arriving  at  the  rate  of  mortality,  the  summaiy  of  each 
published  annual  statement,  excepting  those  prepared  under  the  care  of  the  resident 
physician-in-chief,  has  almost  invariably  overestimated  the  rate  of  mortality  in  the 
obstetrical  wards.     As  an  illustration  of  the  divergence  between  the  summaiy  here- 

1  Philadelphia  Medical  Times,  February  14,  1880, 
8 


114 


EPIDEMICS  IN  THE  PHILADELPHIA  HOSPITAL. 


with  submitted  and  the  summaries  of  the  printed  annual  statements,  it  may  be  seen 
that  the  printed  official  annual  statement  for  the  year  1877  gives  the  total  mortality 
in  the  white  obstetrical  ward  at  41.75  per  cent.,  and  that  of  the  colored  obstetrical 
*  ward  at  50  per  cent. ,  whereas  in  this  summary,  the  total  mortality,  i.  e. ,  the  mor- 
tality among  the  mothers  and  infants  for  1877,-in  the  two  obstetrical  wards  com- 
bined, is  given  as  11.74  per  cent.  The  latter  is  as  nearly  correct  as  can  be  arrived 
at.  The  error  referred  to  was  the  result  of  including  the  children  along  with  the 
mothers  in  the  number  of  inmates,  and  in  determining  mortality." 

Obstetrical  Wards,  Colored  and  White,  Philadelphia  Hospital. 


Years. 


Eh    . 


3  b 


o  * 


a% 


1875 

1876 

1877 

1878 

1879 | 

1880 

1881 

1882 

1883 

1884 

1885 

1875  to  1884,  inclusive 


751 

699 

775 

415 

Not  ascer- 
tainable. 

474 

431 

228 

379? 

427 
377 


266 
244 
277 
209 

181 

183 
196 
102 
205 
219 
194 


5.72 

8.15 

11.74 

13.97 

Not  ascer- 
tainable. 

6.11 
10.90 
12.07 
11.87? 

7.96 

9.25 


4.13 

5.73 

10.83 

2.39 

3.31 

6.01 
4.08 
3.92 
7.32 
3.19 
1.54 


4,579 


111     .  322 


133 


From  April  1,  1885,  to  April  1,  1886.... 


483? 


4.14 


0.80 


' '  The  training-school  for  nurses  took  entire  charge  of  the  matern  i  t y  wards  in  Apri  1 , 
1885.  It  will  be  seen  that  the  number  of  deaths  among  mothers  and  children  com- 
bined has  been  since  the  introduction  of  the  trained  nurses,  4.14  per  cent.,  to  be 
contrasted  with  the  former  mortality  over  a  period  of  eight  (8)  years,  of  9.45  per 
cent. ;  and  the  number  of  deaths  among  mothers,  after  labor,  since  the  introduction 
of  the  new  nurses,  has  been  0.80  percent.,  to  be  contrasted  with  the  former  mor- 
tality of  5.37  per  cent,  over  a  period  of  nine  (9)  years.  The  mortality  during  tbe 
twelve  (12)  months  ending  April  1,  1886,  was  less  than  during  any  year  referred  to 
in  the  above  table." 

"The  new  maternity  buildings  were  occupied  in  January,  1885." 


EPIDEMICS  IN  THE  PHILADELPHIA  HOSPITAL. 


115 


"  The  errors  referred  to  as  existing  in  the  figures  pertaining  to 
the  obstetrical  wards  affect,  also,  the  total  percentage  of  mortality 
from  all  diseases,  but  to  a  less  degree  than  might,  at  first  thought, 
be  expected,  because  these  figures  merge  with  those  representing 
the  other  departments.  The  printed  figures  indicating  the  average 
total  mortality  are,  therefore,  not  so  far  astray  as  the  printed 
figures  indicating  the  mortality  in  the  obstetrical  departments, 
but  for  the  sake  of  accuracy,  we  have  substituted  the  correct  ones. 
In  this  manner  we  ascertain  the  average  mortality  in  the  entire 
hospital,  except  in  the  insane  department,  to  be  : — 

the  printed  report. 


For  the 

year  1875. 

.  8.63  per  cent. 

againsl 

9.53  per  cent,  in 

" 

1876. 

.11.31   " 

u 

12.29   " 

it 

1877. 

.10.89 

u 

11.83   " 

u 

1878. 

.13.17 

u 

13.70   " 

<( 

1879. 

.15.30 

u 

15.30   " 

(I 

1880. 

.13.65   " 

" 

13.70   " 

u 

1881. 

.13.76   " 

" 

14.80   " 

u 

1882. 

.  9.59   " 

a 

9.59   " 

a 

1883. 

.14.35 

a 

14.35   " 

t  t 

1884. 

.10.27 

a 

10.27   " 

" 

1885. 

.11.86   " 

" 

11.86   " 

"  It  will  be  seen  that  no  such  striking  diminution  in  the  mortality  of  the  entire 
hospital  can  he  claimed  for  the  obstetrical  department  in  the  past  year.  In  fact  the 
mortality  for  1885  (11.86  percent.)  is  1.59  percent,  greater  than  that  of  the  previous 
year,  which  was  10.27  per  cent.,  which  was,  however,  low  as  compared  with  the 
year  before  it.  This  may  be  partly  explained  by  the  fact  that  the  burning  of  the 
insane  department  which  occurred  February  12,  1885,  so  crowded  the  wards  of 
the  hospital  that  hygienic  conditions  were  correspondingly  impaired,  and  this  state 
of  affairs  continued  late  into  the  spring. 

' '  In  fairness,  too,  it  should  be  stated,  that  generalizations  dealing  with  so  short  a 
time  as  that  during  which  our  present  system  of  nursing  has  been  in  operation, 
cannot  have  as  much  stress  laid  upon  them  as  if  they  had  been  based  upon  a  longer 
period. 

"  There  are  other  points  of  view  than  the  statistical  whence  our 
present  system  of  nursing  ought  to  be  judged.  By  general 
acknowledgment  of  those  in  a  position  to  know,  our  hospital  from 
being  the  worst  nursed  in  the  city  has  come  to  be  considered 
among  the  best,  and  other  hospitals  far  more  favorably  placed  as 
regards  advantages  of  construction,  the  nature  of  diseases  treated 
and  social  position  of  their  patients,  now  look  upon  it  as  a  model 
worthy  of  imitation.  In  one  hospital,  at  least,  a  great  revolution 
in  its  entire  executive  management  is  about  to  be  inaugurated, 
which  would  not  have  been  thought  of  for  many  years,  at  least, 


116  EPIDEMICS  IN  THE  PHILADELPHIA  HOSPITAL. 

if  the  system  at  the  Philadelphia  Hospital  had  not  attracted  the 
attention  of  those  in  charge  and  secured  their  approval.  Further, 
one  of  our  graduate  nurses  has  recently  been  appointed  chief  nurse 
of  the  Pennsylvania  Hospital. 

"■  Finally,  our  present  system  of  nursing  has  produced  results 
in  a  direction  which  was  scarcely  contemplated  in  its  conception. 
Not  only  are  our  patients  better  cared  for  and  more  comfortable, 
but  a  refining  influence  is  also  exerted  upon  them  of  which  at  first 
thought  they  seem  hardly  susceptible,  and  a  degree  of  self  respect 
is  engendered  which  contributes  to  the  better  discipline  which 
characterizes  the  wards  throughout. 

"Respectfully  submitted  by  order  of  the  medical  board, 

Y7.  H.  Parish,  M.D.,  E.  T.  Bruen,  M.  D, 

Theophilus  Parvin,  M.D,  J.  C.  Wilson,  M.D., 

J.  William  White,  M.D.,  James  Tyson,  M.D., 

George  McClellan,  M.D.,  Chas.  K.  Mills,  M.D., 

Committee." 

Influenza. — This  pandemic  which  swept  over  the  world  in  1889- 
90,  was  the  cause  of  over  three  hundred  severe  cases  being  treated 
in  the  Philadelphia  Hospital.  The  poor  consumptives  were  very 
unfortunate,  forty-five  in  the  medical  wards  being  hurried  oft 
during  three  months,  from  the  middle  of  December,  1889,  to  the 
middle  of  March,  1890.  During  this  period,  sixteen  deaths  occurred 
from  pneumonia,  all  largely  due  to  the  epidemic.  The  mortality 
was  so  great  among  the  phthisis  cases  in  the  fall  of  1890,  that  these 
wards  presented  to  those  familiar  with  their  usual  appearance  a 
very  noticeable  diminution  of  the  array  of  chronic  cases.  There 
were  fourteen  resident  physicians  and  twenty-five  nurses  sick  with 
the  disease,  thus  damaging  the  service  of  the  hospital.  In  the 
insane  department  fifty  cases  occurred  among  the  patients. 


NOTES    ON    THE   HISTORY    AND    ORGANIZATION 
OF  THE  PHILADELPHIA  HOSPITAL  SINCE  1860. 


By  CHARLES  K.  MILLS,  M.D.  and  ROLAND  G.  CURTTN,  M.D. 


We  will  not  attempt  a  continuation  of  Dr.  Agnew's  elaborate 
medical  history  of  the  Philadelphia  Almshouse,  as  the  allotted 
space  in  the  present  volume  will  not  permit  this  to  be  done,  but 
will  simply  note  some  of  the  most  important  historical  facts  of 
the  last  thirty  years,  and  record  the  main  changes  and  new  depart- 
ures in  the  organization  of  the  medical  board.  The  notes  given 
would  be  much  assisted  by  tables  of  the  physicians  and  surgeons 
who  have  been  connected  with  the  hospital,  but  although,  as 
stated  in  the  preface,  such  tables  have  been  nearly  completed, 
their  publication  will  have  to  be  postponed  to  another  volume  of 
Reports,  as  the  present  has  already  extended  to  the  full  limits 
assigned  in  the  authority  given  for  its  publication. 

According  to  the  rules  of  1861,  the  medical  board  of  the  hospital  consisted  of  four 
physicians,  four  surgeons,  and  four  accoucheurs.  The  hospital  was  divided  iuto 
three  departments,  medical,  surgical  and  obstetrical,  and  the  term  of  each  physician, 
surgeon  and  accoucheur  was  three  consecutive  months,  each  staff  regulating  the  order 
in  which  its  different  members  served.  It  was  the  duty  of  each  member  of  the 
staff  in  attendance  to  visit  the  institution  four  times  a  week,  or  oftener,  if  necessary. 

At  various  periods  since  1861,  efforts  have  been  made,  sometimes  successful  and 
sometimes  not,  to  increase  or  decrease  the  number  of  members  of  the  different  staffs 
of  the  hospital.  Four  on  each  staff  remained  the  constitution  of  the  board  until 
1 874.  During  this  year  the  surgical  and  obstetrical  staffs  were  increased  from  four 
members  to  five,  the  medical  staff  xjractically  remaining  at  four,  although  Dr.  D.  D. 
Richardson,  superintendent  of  the  insane  department,  made  five,  as  he  was  regarded 
officially  as  a  member  of  the  medical  staff.  Those  added  to  the  staffs  were  Dr.  S. 
W.  Gross  to  the  surgical,  and  Dr.  J.  R.  Burden,  Jr. ,  to  the  obstetrical.  A  sudden  jump 
was  taken  in  1875.  The  physicians  and  surgeons  were  increased  to  eight  members 
each,  while  the  accoucheurs  remained  at  five.  To  the  surgical  staff  were  added 
Drs.  N.  L.  Hatfield,  J.  William  White  and  W.  G.  Porter  ;  to  the  medical,  Drs.  John 
M.  Keating,  E.  T.  Bruen,  J.  C.  Wilson  and  J.  Guiteras.  These  new  names  appear 
in  the  Annual  Statement  of  the  board  of  guardians  as  full  members  of  the  mediral 

(117) 


118      HISTORY  AND  ORGANIZATION  OF  THE  PHILADELPHIA  HOSPITAL. 

board,  and  were  so  recognized  officially  from  the  first  ;  but  for  a  time  the  impression 
seems  to  have  existed  with  some  that  the  new  members  were  to  be  regarded  as 
jnniors,  not  possessing  all  the  privileges  with  reference  to  lectures  and  some  other 
matters  as  the  four  seniors,  a  view  which,  for  a  time,  caused  some  friction.  Soon, 
however,  all  the  members  of  the  three  staffs  were  considered  as  upon  the  same 
footing. 

In  1876  and  1877,  important  changes  were  made.  The  staff  of  obstetricians  was 
increased  to  eight  members  to  correspond  with  the  surgical  and  medical  staffs.  Of 
the  staff  of  1875,  only  Drs.  Edward  L.  Duer  and  W.  A.  Warder  remained.  Dr.  E. 
M.  Girvin  and  J.  R.  Burden  Jr.,  had  resigned,  Dr.  J.  R,  Parry  had  died,  and  the  new 
members  added  to  the  obstetrical  staff  were  Drs.  J.  B.  Walker,  E.  E.  Montgomery, 
S.  S.  Stryker,  J.  W.  Linn,  M.  D.  Musser  and  W.  H.  Parish.  In  September,  1877, 
three  new  special  departments  were  added  to  the  hospital,  namely,  the  neurological, 
ophthalmological  and  dermatological.  Dr.  Charles  K  Mills  Avas  appointed  to  organize 
and  take  charge  of  wards  for  nervous  diseases  ;  Dr.  E.  O.  Shakespeare  was  made 
ophthalmologist,  and  Dr.  L.  A.  Duhring  dermatologist.  Subsequent  to  this  time  the 
changes  in  the  organization  of  the  medical  board  have  not  been  many,  although  some 
of  them  have  been  important.  The  membership  of  the  neurological  staff  has  been 
increased  until  now  it  numbers  four  ;  the  ophthalmological  and  dermatological  staffs 
have  each  been  enlarged  to  two  members  ;  and  in  1890,  a  laryngological  department 
was  founded,  and  two  laryngologists,  Drs.  C.  Jay  Seltzer  and  George  Morley  Mar- 
shall were  appointed.  Several  important  changes  have  been  made  with  reference 
to  the  positions  of  pathologist,  assistant  pathologist,  curator  and  microscopist,  and 
in  1890,  a  bacteriologist  was  appointed. 

From  1880  to  1884,  the  medical  and  surgical  staffs  numbered  nine.  One  reason 
for  this  abnormal  increase  was  probably  the  great  pressure  brought  upon  the  govern- 
ing board  in  behalf  of  gentlemen  who  had  command  of  powerful  influence.  When 
in  1884,  it  was  suggested  to  decrease  the  staffs,  the  medical  board  united  in  opposi- 
tion to  this,  possibly  influenced  to  some  extent  by  the  uncertainty  as  to  who  would 
be  selected  for  the  axe.  Notwithstanding  this,  however,  at  a  meeting  of  the 
board  of  guardians,  October  27,  1884,  a  rule  was  adopted  reducing  each  staff  to  six. 
The  rule  in  full  was,  that  the  medical  board  should  consist  of  a  medical,  surgical 
and  obstetrical  staff,  not  exceeding  six  members  each  ;  also  of  a  neurologist,  a 
dermatologist,  a  pathologist,  who  should  serve  as  curator,  a  microscopist,  and  a 
physician  to  the  insane  department. 

In  December,  1889,  numerous  changes  were  made  in  the  per- 
sonnel of  the  medical  board. 

The  rules  for  1890  divide  the  hospital  into  four  departments, 
viz.,  a  medical,  surgical,  obstetrical  and  neurological ;  the  medical 
including  the  medical  wards  only;  the  surgical,  the  surgical, 
venereal,  eye  and  skin  wards;  the  obstetrical,  maternity,  gyne- 
cological and  convalescent  wards,  the  nursery  and  the  children's 
department ;  the  neurological,  the  nervous  wards  and  the  insane 
department.  In  addition  special  wards  are  under  the  care  of 
ophthalmologists,  dermatologists  and  laryngologists.  The  terms 
of  service  of  the  visiting  medical  officers  is  fixed  by  their  respective 
staffs.   ■ 


HISTORY  AND  ORGANIZATION  OP  THE  PHILADELPHIA  HOSPITAL.     119 

The  medical  board  under  the  present  rules  is  elected  annually 
in  December,  by  a  vote  of  the  majority  of  the  members  of  the 
board  of  charities  and  correction,  and  vacancies  on  the  board  are 
filled  by  a  similar  vote  for  the  unexpired  term,  at  the  next  stated 
meeting  of  said  board,  following  the  one  at  which  the  vacancy 
is  declared.  The  medical,  surgical,  and  obstetrical  staffs  are 
composed  of  eight  members  each  ;  the  neurological  staff  of  four ; 
in  addition,  the  board  consists  of  f,wo  ophthalmologists,  two 
dermatologists,  two  laryngologists,  a  pathologist,  with  two  assist- 
ant pathologists,  and  a  bacteriologist.  The  board  elects  annually 
by  ballot  a  president  and  a  secretary. 


OFFICERS  OF  THE  MEDICAL  BOARD. 

It  may  be  of  some  interest  to  record  the  names  of  those  who 
have  been  honored  at  various  times  by  election  to  the  offices  of 
the  medical  board.  The  president  of  the  board  has,  as  a  rule, 
been  chosen  from  the  older  and  more  distinguished  members. 
The  record  of  these  positions  is  not  a  complete  one,  but  from 
the  minutes  of  the  medical  board  some  facts  in  regard  to  them 
have  been  obtained.  The  minute  book  now  in  the  hands  of 
the  secretary  begins  in  1859,  but  for  several  years  no  minutes 
appear. 

At  a  meeting  of  the  board,  held  August  13,  1859,  Dr.  Samuel  D.  Gross  was 
nominated  and  unanimously  elected  chairman,  and  Dr.  John-  Wiltbank  was 
appointed  secretary.  Dr.  Edward  L.  Duer  subsequently  became  secretary  : 
March  30,  1867,  he  resigned,  and  Dr.  William  Pepper  was  appointed  in  his  place. 
January  15,  1868,  Dr.  Alfred  Stille"  was  elected  president,  and  was  re-elected  for 
several  years,  resigning  March  8,  1872,  when  Dr.  J.  L.  Ludlow  was  elected.  Jan- 
uary 4,  1869,  Dr.  Pepper  resigned  the  secretaryship,  and  was  succeeded  by  Dr. 
Jonn  S.  Parry,  who  continued  in  this  position  until  February  17,  1871,  when  he 
resigned  and  Dr.  Harrison  Allen  was  elected.  Dr.  Allen  was  succeeded  by  Dr. 
John  Guiteras,  October  7,  1878.  The  next  year  Dr.  Guiteras  having  resigned  from 
the  hospital  to  go  into  the  Marine  Hospital  service,  Dr.  E.  T.  Bruen  was  elected 
secretary,  and  continued  to  serve  as  such  until  his  death  in  1889.  Dr.  Ludlow  was 
succeeded  as  president  by  Dr.  James  Tyson,  March  10,  1885.  Dr.  Roland  G. 
Curtin  was  elected  president  January  6,  1890.  Since  the  death  of  Dr.  Bruen 
Dr  L.  Steinbach  has  been  secretary. 


120     HISTORY  AND  ORGANIZATION  OP  THE  PHILADELPHIA  HOSPITAL. 
LIST  OF  MEMBERS  OF  THE  MEDICAL  BOARD. 

With    Addresses,    Place  and   Time   of   Graduation,  date    of    Appointment  to  the 
Philadelphia  Hospital,  and  Positions  held  in  other  Institutions. 

In  the  main,  this  list  as  arranged  represents  the  order  of  senior- 
ity of  the  different  members  of  the  medical  board.  In  a  few 
instances,  however,  it  does  not,  as  present  members  of  the  board 
are  serving  for  a  second  period.  Dr.  James  B.  Walker  was  first 
elected  in  1876.  During  a  few  months  in  1885  he  was  not  a 
member  of  the  board,  but  was  re-appointed  during  the  same  year. 
Dr.  E.  E.  Montgomery  was  first  elected  in  1877;  ceased  to  be  a 
member  of  the  board  in  1885,  and  was  re-appointed  in  1886.  Dr. 
James  Hendrie  Lloyd  was  elected  to  the  neurological  staff  in  place 
of  Dr.  Roberts  Bartholow,  who  resigned  January  1, 1888;  he  served 
until  December,  1889,  and  was  re-appointed  in  December,  1890. 
Some  members  of  the  different  staffs  have  been  elected  during 
the  same  year,  or  even  at  the  same  meeting  of  the  governing 
board,  and  practically  the  latter  do  not  differ  in  seniority.  In 
these  cases  we  have  taken  the  names  in  the  order  in  which  they 
appear  in  the  printed  Reports  of  the  department. 

William  G.  Porter,  M.D.,  1223  Spruce  street.  Graduate  of  Univ.  Penna.,  1868. 
Appointed  1 875.  Surgeon  to  the  Presbyterian  Hospital ;  Consulting  Surgeon 
to  the  Philadelphia  Dispensary. 

James  B.  Walker,  M.D.,  1617  Green  street.  Graduate  of  Univ.  Penna.,  1872. 
Appointed  1876  ;  served  until  1885  ;  re-appointed  same  year.  Professor  of  the 
Practice  of  Medicine  in  the  Woman's  Medical  College  of  Pennsylvania  ;  Con- 
sulting Physician  and  Lecturer  on  Clinical  Medicine  in  the  Woman's  Hospital 
of  Philadelphia  ;  Secretary  of  the  American  Climatological  Society,  etc. 

E.  E.  Montgomery,  M.D.,  1818  Arch  street.  Graduate  of  Jefferson  Medical  Col- 
lege, 1874.  Appointed  1877 ;  served  until  1885  ;  re-appointed  1886.  Pro- 
fessor of  Gynecology  in  the  Medico-Chirurgical  College  :  Gynecologist  to  the 
Medico-Chirurgical  Hospital . 

Charles  K.  Mills,  M.D.,  1909  Chestnut  street.  Graduate  of  Univ.  Penna  ,  1869. 
Appointed  1877.  Professor  of  Diseases  of  the  Mind  and  Nervous  System  in  the 
Philadelphia  Polyclinic ;  Lecturer  on  Mental  Diseases  in  the  University  of 
Pennsylvania  ;  Lecturer  on  Nervous  Diseases  in  the  Woman's  Medical  College 
of  Pennsylvania. 

E.  O.  Shakespeare,  M.  D.,  1336  Spruce  street.  Graduate  of  Univ.  Penna.,  1869. 
Appointed  ophthalmologist,  1877  ;  curator,  1880  ;  pathologist,  1882  ;  bacterio- 
logist, 1889. 

Henry  F.  Form  ad,  M.D.,  3535  Locust  street.  Graduate  of  Univ.  Penna.,  1877. 
Appointed  microscopist,  1878  ;  pathologist,  1887.  Demonstrator  of  Pathology 
in  the  University  of  Pennsylvania  ;  Coroner's  Physician,  Philadelphia. 


HISTORY  AND  ORGANIZATION  OP  THE  PHILADELPHIA  HOSPITAL.     121 

Roland  G.  Ccrtin,  M.D.,  22  South  Eighteenth  street.  Graduate  of  Univ.  Penna., 
1866.  Appointed  1880.  Consulting  Physician  to  the  Rush  Hospital  for  Con- 
sumptives, and  to  St.  Timothy's  Hospital  and  the  Midnight  Mission  ;  Visiting- 
Physician  to  the  Presbyterian  Hospital ;  Lecturer  on  Physical  Diagnosis  in  the 
University  of  Pennsylvania  ;  Assistant  Physician  to  the  Hospital  of  the  Uni- 
versity of  Pennsylvania,  West  Philadelphia. 

W.  Joseph  Hearn,  M.D.,  1130  Walnut  street.  Graduate  of  Jefferson  Medical 
College,  1867.  Appointed  1882.  Visiting  Surgeon  to  the  Jefferson  Medical 
College  Hospital ;  Lecturer  on  Clinical  Surgery  in  the  Jefferson  Medical  College. 

Clara  Marshall,  M.D.,  131  South  Eighteenth  street.  Graduate  of  Worn.  Med. 
Coll.  Penn.,  1875.  Appointed  1882.  Dean  and  Professor  of  Therapeutics  in 
the  Woman's  Medical  College  of  Pennsylvania  ;  Attending  Physician  to  the 
Girls'  Department  of  the  House  of  Refuge. 

Theophiltjs  Parvin,  M.D.,  1626  Spruce  street.  Graduate  of  Univ.  Penna.,  1852. 
Appointed  1884.  Professor  of  Obstetrics  and  the  Diseases  of  Women  and 
Children  in  Jefferson  Medical  College,  etc. 

Lewis  W.  Steinbach,  M.D.,  716  Franklin  street.  Graduate  of  Jefferson  Medical 
College,  1880.  Appointed  1885.  Surgeon  to  the  Jewish  Hospital  ;  Professor 
of  Surgery  in  the  Philadelphia  Polyclinic. 

A.  W.  Ransley,  M.  D.,  1222  S.  Tenth  street.  Graduate  of  Univ.  Penna.,  1675. 
Appointed  1885.     Surgeon  to  St.  Agnes'  Hospital. 

John  H.  Musser,  M.D.,  N.  E.  corner  Fortieth  and  Locust  streets.  Graduate  of 
Univ.  of  Penna.,  1877.  Appointed  1885.  Assistant  Professor  of  Clinical 
Medicine  in  University  Pennsylvania  :  Physician  to  the  Presbyterian  Hospi- 
lal ;  Consulting  Physician  to  the  Woman's  Hospital,  and  to  the  West  Phila- 
delphia Hospital  for  Women. 

Guy  Hinsdale,  M.D.,  4011  Chestnut  street.  Graduate  of  Univ.  Penna.,  1881. 
Appointed  1886.  Assistant  Physician  to  Presbyterian  Hospital ;  Assistant 
Physician  to  Orthopedic  Hospital  and  Infirmary  for  Nervous  Diseases  ;  Curator 
of  the  College  of  Physicians. 

Henry  W.  Stelwagon,  M.D.,  1411  Spruce  street.  Graduate  of  Univ.  Penna., 
1875.  Appointed  1887.  Clinical  Lecturer  on  Dermatology  in  the  Jefferson  and 
Woman's  Medical  Colleges  ;  Physician  to  the  Skin  Departments  of  the  Howard 
Hospital  and  of  the  Northern  Dispensary. 

Francis  X.  Dercum,  M.D.,  636  North  Eighth  street.  Graduate  of  Univ.-  Penna., 
1877.  Appointed  1887.  Instructor  in  Nervous  Diseases  in  the  University  of 
Pennsylvania  ;  Assistant  Physician  to  the  Orthopedic  Hospital  and  Infirmary 
for  Nervous  Diseases. 

G.  E.  de  Schweinitz,  M.D.,  1401  Locust  street.  Graduate  of  Univ.  Penna., 
1881.  Appointed  1887  Ophthalmic  Surgeon  to  the  Children's  Hospital,  and 
to  the  Orthopedic  Hospital  and  Infirmary  for  Nervous  Diseases  ;  Surgeon  to 
the  Dispensary  of  the  University  Hospital  for  Diseases  of  the  Eye. 

John  Blair  Deaver,  M.D.,  .120  South  Eighteenth  street.  Graduate  of  Univ. 
Penna.,  1878.  Appointed  1887.  Professor  of  Surgery  in  the  Philadelphia 
Polyclinic  ;  Demonstrator  of  Anatomy  and  Lecturer  on  Surgical  Anatomy  in 
the  University  of  Pennsylvania  ;  Attending  Surgeon  to  the  German,  St.  Mary's 
and  St.  Agnes'  Hospitals  ;  and  Consulting  Surgeon  to  St.  Timothy's  Hospital, 


122     HISTORY  AND  ORGANIZATION  OP  THE  PHILADELPHIA  HOSPITAL. 

Barton  Cooke  Hirst,  M.D.,  248  South  Seventeenth  street.  Graduate  of  Univ. 
Penna.,  1883.  Appointed  1887.  Professor  of  Obstetrics  in  the  University  of 
Pennsylvania ;  Obstetrician  to  the  University  and  Maternity  Hospitals  ; 
Gynecologist  to  the  Orthopedic  Hospital. 

James  Hendrie  Lloyd,  M.D.,  S.  W.  corner  Walnut  and  Fortieth  streets.  Grad- 
uate of  Univ.  Penna.,  1878.  Appointed  1888  ;  served  until  December,  1889  ; 
re-appointed  December,  1890.     Physician  to  the  Home  for  Crippled  Children. 

Edward  P.  Davis,  M.D.,  250  South  Twenty -first  street.  Graduate  of  Rush 
Medical  College,  Chicago.  1882.  Appointed  1888.  Professor  of  Obstetrics  and 
Diseases  of  Children  in  the  Philadelphia  Polyclinic  ;  Clinical  Lecturer  on 
Obstetrics  in  the  Jefferson  Medical  College  ;  Attending  Physician  to  the  Foulke 
and  Long  Orphanage,  and  to  the  Clinton  street  Boarding  Home  for  Women. 

Frederick  P.  Henry,  M.D.,  1635  Locust  street.  Graduate  of  College  of  Phy- 
sicians and  Surgeons,  New  York,  1868.  Appointed  1888.  Plrvsician  to  the 
Jefferson  Medical  College  Hospital  ;  Lecturer  on  Clinical  Medicine  at  the 
Jefferson  Medical  College. 

Wharton  Sinkler,  M.D.,  1606  Walnut  street.  Graduate  of  Univ.  Penna.,  1868. 
Appointed  1888.  Physician  to  Orthopedic  Hospital  and  Infirmary  for  Nervous 
Diseases  ;  Manager  of  the  Episcopal  Hospital  ;  President  of  the  American 
Neurological  Association. 

J.  M.  Anders,  M.D.,  1637  North  Broad  street.  Graduate  of  Univ.  Penna.,  1877. 
Appointed  1889.  Professor  of  Clinical  Medicine  and  Hygiene  in  the  Medico- 
Chirurgical  College  ;  Physician  to  the  Episcopal  and  to  the  Medico-Chirur- 
gical  Hospitals. 

W.  E.  Hughes,  M.D.,  3796  Baring  street,  Graduate  of  Univ.  Penna.,  1880. 
Appointed  1889.     Secretary  of  the  Pathological  Society  of  Philadelphia. 

Solomon  Solis-Cohen,  M.D.,  219  South  Seventeenth  street.  Graduate  of  Jeffer- 
son Medical  College,  1883.  Appointed  1889.  Professor  of  Clinical  Medicine 
and  Applied  Therapeutics  in  the  Philadelphia  Polyclinic  ;  Lecturer  on  Clinical 
Medicine  and  Therapeutics  in  the  Jefferson  Medical  College  ;  Lecturer  on 
Therapeutics  in  Dartmouth  Medical  College  ;  Consulting  Physician  to  the 
Jewish  Hospital. 

Eugene  L.  Vansant,  M.D.,  1632  Chestnut  street.  Graduate  of  Jefferson  Med- 
ical College,  1884.  Appointed  1889.  Demonstrator  of  Histology  in  Jefferson 
Medical  College  ;  Visiting  Physician  to  the  Howard  Hospital. 

Orville  Horwitz,  M.D.,  1115  Walnut  street.  Graduate  of  Jefferson  Medical 
College,  1883.  Appointed  1889.  Demonstrator  of  Surgery  in  Jefferson  Med- 
ical College  ;  Chief  of  the  Out-Door  Surgical  Department  of  Jefferson  Medical 
College  Hospital. 

Ernest  Laplace,  M.D.,  1617  Arch  street.  Graduate  of  Univ.  La.,  1864.  Ap- 
pointed 1889.    Professor  of  Clinical  Surgery  in  the  Medico- Chi rurgical  College. 

Witliam  Easterly  Ashton,  M.D.,  338  South  Fifteenth  street.  Graduate  of 
Univ.  Penna.,  1884.     Appointed  1889. 

C.  S.  Bradfute,  M.D.,  1336  Spruce  street.  Graduate  of  Jefferson  Medical  College, 
1887.  Appointed  1889.  Demonstrator  of  Therapeutics  in  the  Jefferson  Med- 
ical College. 


HISTORY  AND  ORGANIZATION  OF  THE  PHILADELPHIA  HOSPITAL.      123 

George  M.  Gould.  M.D.,  119  South  Seventeenth  street.  Graduate  of  Jefferson 
Medical  College,  1888.     Appointed  1889. 

J.  Abbott  Cantrell,  M.D.,  261  South  Fifteenth  street.  Graduate  of  Jefferson 
Medical  College,  1885.  Appointed  1889.  Adjunct  Professor  of  Dermatology 
in  the  Philadelphia  Polyclinic. 

J.  Leffixgwell  Hatch,  M.D.,  3615  Locust  street.  Graduate  of  Univ.  Penna,, 
1888.  Appointed  1839.  Lecturer  on  Bacteriology  and  Assistant  Demonstrator 
of  Morbid  Anatomy  and  Pathological  History  in  the  University  of  Pennsyl- 
vania ;  Curator  of  the  Pathological  Society  of  Philadelphia. 

Henry  Ware  Cattell.  M.D.,  3709  Spruce  street.  Graduate  of  Univ.  Penna., 
1887.  Appointed  1889.  Assistant  Demonstrator  of  Chemistry  in  the  University 
of  Pennsylvania;  Physician  in  the  Children's  Dispensary,  St.  Clement's  Hos- 
pital ;  Assistant  Surgeon  to  the  Orthopedic  Dispensary  of  the  University 
Hospital. 

James  M.  Barton,  M.D.,  1337  Spruce  street.  Graduate  of  Jefferson  Medical 
College,  1868.  Appointed  1890.  Surgeon  to  the  Jefferson  Medical  College 
Hospital. 

C.  Jay  Seltzer,  M.D.,  23  South  Sixteenth  street.  Graduate  of  Univ.  Penna., 
1881.  Appointed  1890.  Ophthalmic  Surgeon  to  Howard  Hospital  and  Southern 
Home  for  Destitute  Children  ;  Assistant  Ophthalmologist  and  Surgeon  to  the 
Wills  Eye  Hospital. 

George  Morley  Marshall,  1700  Girard  avenue.  Graduate  of  Univ.  Penna.. 
1886.     Appointed  1890.     Attending  Physician  to  St.  Joseph's  Hospital. 

Robert  H.  Hamill,  M.D.,  330  South  Sixteenth  street.  Graduate  of  Univ.  Penna., 
1878.  Appointed  1890.  Obstetrician  to  Maternity  Hospital ;  Gynecologist 
to  the  Howard  Hospital. 

George  I.  McKelway,  M.D.,  116  North  Seventeenth  street.  Graduate  of  Univ. 
Penna.,  1889.     Appointed  1890. 

Frederick  A.  Packard,  M.D.,  259  South  Fifteenth  street.  Graduate  of  Univ. 
Penna.,  1885.  Appointed  1890.  Instructor  in  Physical  Diagnosis  University 
of  Pennsylvania  :  Visiting  Physician  to  the  Medical  Dispensary  of  the  Epis- 
copal Hospital. 

Richard  C.  Norris,  M.D.,  1234  Spruce  street,  Graduate  of  Univ.  Penna.,  1887. 
Appointed  1890.    Demonstrator  of  Obstetrics  in  the  University  of  Pennsylvania. 

J.  Chalmers  Da  Costa,  M.  D.,  2050  Locust  street.  Graduate  of  Jefferson  Medi- 
cal College,  1885.     Appointed  1890. 

Since  the  "  Bullitt  bill "  has  been  in  operation,  certain  rules  and 
regulations  adopted  by  the  mayor  and  his  heads  of  departments 
apply  to  the  examination  of  some  of  the  many  who  receive 
appointments  in  the  Philadelphia  Hospital.  The  mayor  is  chair- 
man of  the  civil  service  board,  which  is  composed  of  himself  and 
the  heads  of  departments.  Boards  of  examiners  are  appointed  for 
determining   the   fitness    of  all  applicants   for    appointment    or 


124     HISTORY  AND  ORGANIZATION  OF  THE  PHILADELPHIA  HOSPITAL. 

promotion,  by  open,  competitive  examination.  The  separate 
boards  are  arranged  under  various  "schedules."  Under  schedule 
E,  for  instance,  comes  the  examination  of  surgeons,  physicians, 
veterinary  surgeons,  chemists,  druggists,  superintendents,  moral 
instructors,  nurses,  heads  of  training  schools,  matrons,  house- 
keepers, helpers  and  attendants  at  the  house  of  correction,  alms- 
house and  hospital.  The  board  of  examiners  for  this  schedule 
is  composed  of  three  physicians  or  surgeons  in  good  standing. 

During  1887-88-89,  for  the  examination  of  nurses,  heads 
of  the  training  schools,  attendants,  and  assistant  physicians 
in  the  insane  department  of  the  hospital,  Drs.  James  Tyson, 
Charles  K.  Mills,  Francis  X.  Dercum  and  Edward  Martin  served, 
Dr.  Martin  for  part  of  the  term,  succeeding  Dr.  Tyson,  who  resigned. 
In  1890,  the  work  was  divided  into  two  classes,  and  resident  phy- 
sicians as  well  as  the  other  medical  attendants  were  included  in 
those  to  be  examined  under  the  first  class.  The  board  of  exam- 
iners appointed  for  this  class  consists  of  Drs.  Henry  C.  Chapman, 
AAllliam  F.  Waugh  and  Roland  G.  Curtin.  For  the  examination 
of  the  second  class,  including  superintendents,  moral  instructors, 
nurses,  heads  of  training  schools,  matrons,  housekeepers,  helpers 
and  attendants,  the  board  appointed  consists  of  Drs.  James  C. 
Wilson,  Robert  Dornan  and  Alexander  W.  Ransley. 


RECOEDER  OR  REGISTRAR. 

At  various  times  in  the  history  of  the  Philadelphia  Hospital, 
efforts  have  been  made  to  introduce  an  efficient  system  of  keeping- 
clinical  and  other  records.  Dr.  Agnew  refers  to  the  fact  that  as 
early  as  1824,  the  medical  board  advocated  the  election  of  two 
additional  pupils  as  recorders,  but,  as  he  states,  nothing  of  prac- 
tical importance  seems  to  have  come  of  the  creation  of  this  office. 
To  this  day  efforts  in  the  same  direction  have  not  been  rewarded 
with  much  success.  In  the  hospitals  abroad,  notably  in  those  of 
London,  the  position  of  registrar  is  ranked  as  one  of  importance; 
in  some  instances  the  office  is  sub-divided  into  senior  and  junior 
registrar.  The  positions  seem  to  be  sought  after,  and  to  be  used 
to  the  great  advantage,  both  of  patients  and  physicians.  No  good 
reason  exists  why  this  should  not  be  the  case  in  the  Philadel- 
phia and  in  other  American  hospitals. 


HISTORY  AND  ORGANIZATION  OF  THE  PHILADELPHIA  HOSPITAL.      125 

On  December  10,  1851,  the  minutes  of  the  stated  meeting  of  the  hoard  of  guar- 
dians show  that  a  communication  was  read  from  Drs.  DaCosta  and  Tutt,  asking 
for  the  appointment  of  a  medical  recorder  to  aid  the  attending  physicians  and 
surgeons,  but  so  far  as  we  can  learn  this  request  was  not  granted.  In  1885  the 
medical  board  of  the  hospital,  after  several  meetings,  adopted  a  resolution  recom- 
mending the  appointment  of  registrars,  and  soon  after  the  position  was  created  by 
the  board  of  guardians,  and  four  registrars  were  elected  ;  one  for  the  medical 
wards  ;  one  for  the  surgical,  venereal,  skin  and  eye  wards  ;  one  for  the  obstetrical, 
gynecological  and  children's  wards,  and  one  for  the  nervous  and  insane  wards. 
The  duties  of  registrar  have  varied  somewhat  under  different  rules,  but  in  the 
main  they  have  been  much  the  same  as  in  the  printed  rules  for  May,  1890,  of 
which  the  following  are  the  chief  : 

''It  shall  be  the  duty  of  the  registrar  to  see  that  a  correct  and  sufficiently  full 
history  is  Avritten  for  each  case  within  forty-eight  hours  after  admission,  and  that 
on  the  discharge  of  such  case,  the  diagnosis,  treatment,  and  result  of  treatment,  are 
properly  observed  on  the  history  sheets. 

"The  registrar  shall  refer  back  to  the  resident  such  histories  as  are  unsatisfactory, 
and  on  failure  of  the  latter  to  return  them  properly  filled  within  twenty-four  hours, 
shall  report,  in  writing,  such  failure  to  the  chief  resident  physician. 

"The  registrar  shall,  at  the  end  of  each  year,  labulate  the  cases  in  the  respective 
wards  for  insertion  in  the  annual  report,  and  the  labor  of  preparing  this  report  shall 
chiefly  devolve  on  the  four  registrars. 

"The  registrar  shall  visit  the  hospital  not  less  than  three  times  each  week,  record- 
ing in  the  proper  book  the  time  of  arrival  and  departure.  He  shall  see  that  the 
head  nurse  of  each  ward  keeps  a  record  of  all  the  operations  performed  in  that  ward. 
He  shall  personally  take  the  histories  of  such  cases  as  are  designated  by  his  chiefs, 
and  shall  in  the  absence  and  at  the  request  of  the  latter,  after  the  other  members 
of  the  staff  have  been  asked  to  serve,  act  as  their  substitute  in  the  wards." 


RESIDENT  PHYSICIANS. 

The  system  of  resident  physicians  has  changed  a  number  of 
times  in  the  history  of  the  institution.  Two  forms  of  medical 
residency  must  be  considered  in  recalling  the  facts — the  admin- 
istration under  a  resident  physician-in-chief,  and  the  service  of 
resident  physicians,  usually  recent  graduates,  elected  for  short 
periods.  Dr.  Agnew  has  given  the  history  of  the  administration 
under  chief  resident  physicians  up  to  the  period  with  which  his 
lecture  closes.  From  this  record  it  will  be  seen  that  between  1 845 
and  1854,  this  position  was  in  existence  and  was  occupied  by 
several  doctors,  each  filling  comparatively  short  terms.  In  1854, 
a  board  of  lecturers  on  clinical  medicine  and  surgery  was  ap- 
pointed, but  the  administration  by  a  resident-in-chief  was  contin- 
ued. In  1859,  the  office  of  chief  resident  was  abolished  and  the 
hospital  was  placed  in  charge  of  a  visiting  medical  board. 


126     HISTORY  AND  ORGANIZATION  OF  THE  PHILADELPHIA  HOSPITAL. 

So  far  as  we  know,  from  this  time  until  1870,  no  resident  executive  position  in 
the  hospital  was  in  existence.  At  the  meeting  of  the  board  of  guardians  November 
21,  1870,  a  discussion  took  place  regarding  the  expediency  of  appointing  a  hospital 
warden,  whose  duties,  salary,  etc.,  were  also  considered.  At  a  meeting  of  the  board 
held  December  28,  1870,  L.  D.  Kemple  was  elected  hospital  warden.  The  name  of 
this  gentleman  appears  as  hospital  warden,  in  the  Annual  Statement  of  the  guar- 
dians for  December  31,  1870.  Neither  the  position  nor  the  name  of  its  occupant, 
however,  appears  in  the  Annual  Statements  for  1871,  1872,  1873,  1874.  Probably 
the  position  only  remained  in  force  for  a  short  time.  If  such  was  the  case,  in  1875, 
it  was  re-created  and  Mr.  William  Airey  was  appointed,  aud  continued  to  hold  the 
office  until  1882.  In  1882,  Mr.  T.  S.  Collins  was  appointed  hospital  warden, 
aud  was  succeeded  in  1883,  by  Dr.  Thomas  N.  McLaughlin,  who  was  at  the  time 
one  of  the  staff  of  internes.  In  1885,  the  position  of  hospital  warden  was  again 
abolished,  and  that  of  physician-in-chief  to  the  hospital  created  in  its  stead, 
Dr.  McLaughlin  being  elected  to  the  new  position.  On  the  re-organization  of  the 
hospital  in  1887,  Dr.  George  M.  Wells  was  made  chief  resident  physician,  and  the 
position  was  now  made  to  include  that  of  physician-in-chief  to  the  insane  depart- 
ment. Dr.  Wells  resigned  January  13,  1890,  his  resignation  taking  effect  about 
one  month  later.  In  a  short  time  the  present  incumbent,  Dr.  Daniel  E.  Hughes, 
was  appointed. 

The  duties  of  the  resident-in-chief  or  chief  resident  physician  have  varied  some- 
what under  the  rules  adopted  at  different  periods  ;  those  of  hospital  warden  were 
similar,  but  not  as  extensive,  and  did  not  include  some  of  the  powers  which  could 
only  be  exercised  by  a  medical  graduate.  The  following  are  the  chief  duties  as 
prescribed  in  the  rules  adopted  in  May,  1890  : — 

He  shall  have  the  general  supervision  of  the  hospital  in  all  its  departments  ;  he 
shall  be  physician-iu-chief  of  the  insane  department  of  the  hospital ;  he  shall  have 
full  control  of  the  resident  physicians,  and  shall  see  that  they  faithfully  perform  their 
duties  and  conduct  themselves  with  decorum  at  all  times  when  within  the  institu- 
tion, and  shall  report  to  the  bureau  any  dereliction  on  their  part ;  he  shall  have 
control  and  general  management  of  all  the  nurses  and  attendants  connected  with 
the  hospital.  The  library  shall  be  under  the  superintendence  and  direction  of  the 
chief  resident  physician  ;  and  it  shall  be  the  duty  of  the  person  engaged  for  that 
purpose  to  see  that  all  the  books  are  catalogued,  labelled  and  numbered. 

Resident  medical  students  or  resident  physicians  serving  for 
comparatively  short  periods  have  been  a  part  of  the  medical  ser- 
vice of  the  hospital  as  far  back  as  1808,  and  perhaps  earlier.  In 
1788,  as  related  by  Dr.  Agnew,  an  apothecary  was  first  appointed, 
and  he  was  required  to  be  either  a  graduate  or  an  advanced  stu- 
dent, so  that  this  might  be  regarded  as  the  beginning  of  the  office 
of  resident  physician.  A  little  later,  more  than  one  resident  stu- 
dent was  deemed  necessary,  and  the  manner  in  which  the  num- 
ber of  resident  pupils  was  increased,  and  in  which  they  were 
sub-divided  into  seniors  and  juniors,  is  also  related  by  Dr.  Agnew. 
In  1823,  a  rule  was  adopted  requiring  the  resident  physicians  to 
be  graduates,  and  from  that  period  to  the  present  the  house  has 


HISTOEY  AND  ORGANIZATION  OF  THE  PHILADELPHIA  HOSPITAL.      127 

always  had  a  corps  of  resident  physicians,  the  number  of  which 
has  gradually  increased,  until  at  the  present  time  the  maximum 
is  twenty,  to  serve  fifteen  months  each,  and  sixteen  to  be  elected 
annually. 

Oar  list  of  resident  physicians,  which  has  grown  into  hundreds  and  reaches  hack 
to  the  beginning  of  the  present  century,  contains  not  a  fesv  of  the  names  which 
have  reached  the  highest  distinction  in  American  medicine.  In  1862,  Dr.  Agnew 
said  that  among  the  names  of  the  resident  physicians  of  the  Philadelphia  Hospital 
will  be  found  those  of  the  most  distinguished  physicians,  dead  and  living,  from 
the  north  and  south,  for  the  last  quarter  of  a  century,  and  such  a  statement  can 
be  made  with  equal,  if  not  greater  truth  of  those  who  have  occupied  the  position 
of  Blockley  internes  since  the  year  1862. 

At  present  and  for  a  number  of  years  the  positions  of  resident  physicians,  filled 
by  competitive  examination,  have  been  held,  as  a  rule,  by  young  men  and  women 
of  the  highest  ability  and  character.  The  rules  governing  them  are  comprehensive 
and  strict  in  character  ;  they  have  great  opportunities  for  improvement  and 
advancement,  and  their  duties  are  sufficiently  arduous  and  exacting  to  call  forth 
the  best  qualities  of  mind  and  body. 


ASSOCIATION  OF  EX-EESIDENT  PHYSICIANS  OF  THE  PHILADELPHIA 

HOSPITAL. 

On  October  25,  1887,  a  meeting  of  the  ex-resident  physicians 
of  the  Philadelphia  Hospital  was  held  in  the  lower  lecture-room 
of  the  college  of  physicians,  Thirteenth  and  Locust  streets.  Dr. 
S.  W.  Gross  was  elected  chairman,  and  Dr.  J.  B.  Walker  temporary 
secretary.  A  committee  of  six  was  appointed  to  draft  a  plan  for 
a  permanent  organization  and  a  banquet.  This  committee  con- 
sisting of  Drs.  H.  C.  Wood,  William  H.  Parish,  P.  Wilmot  Deaver, 
William  G.  Porter,  William  A.  N.  Dorland,  DeForrest  Willard 
and  S.  W.  Gross  (ex  officio),  was  instructed  to  report  at  such  time 
as  it  deemed  suitable,  and  to  present  as  complete  a  list  of  ex- 
resident  physicians  as  possible.  On  motion  it  was  decided  that 
the  organization  should  be  composed  only  of  the  ex-resident 
physicians  and  resident  physicians  of  the  Philadelphia  Hospital. 

On  November  16,  1887,  another  meeting  of  the  resident  physicians  of  the  Phila- 
delphia Hospital  was  called,  the  committee  on  organization  made  a  report,  and  the 
following  articles  were  adopted  : — 

1.  That  the  association  shall  be  composed  of  the  ex-resident  and  resident  physi- 
cians of  the  Philadelphia  Hospital. 

2.  That  the  officers  shall  consist  of  a  president,  two  vice-presidents,  a  secretary 
and  an  executive  committee. 


128     HISTORY  AND  ORGANIZATION  OF  THE  PHILADELPHIA  HOSPITAL. 

3.  The  executive  committee  shall  he  composed  of  seven  memhers.  The  presi- 
dent, vice-presidents  and  secretary  shall  be  ex-officio  members  of  the  commiitee. 

4.  That  it  shall  be  the  duty  of  the  executive  committee  to  make  all  arrangements 
for  an  annual  banquet,  which  shall  be  held  on  the  first  Tuesday  in  December. 

5.  That  the  president  shall  appoint  a  nomriating  committee,  who  shall  report 
at  the  annual  banquet  the  names  of  the  officers  and  executive  committee  for  the 
ensuing  year,  and  that  such  report  shall  be  equivalent  to  an  election. 

The  following  were  the  first  officers  elected  :  president,  Prof.  Alfred  Stille  ;  vice- 
presidents,  Prof.  S.  W.  Gross,  Dr.  S.  S.  Stoker  ;  secretary,  Dr.  W.  A.  N.  Dorland  ; 
executive  committee,  Drs.  J.  Ewing  Mears,  R.  G.  Curtin,  J.  W.  O'Neill,  J.  H. 
Musser,  R.  W.  Deaver,  H.  W.  Elmer,  J.  H.  Jamre. 

On  motion  the  executive  committee  was  authorized  to  provide  a  banquet  on  the 
evening  of  the  6th  day  of  December. 

Each  year  since,  the  Association  has  held  a  meeting  and  had  a 
banquet.  Two  addresses  before  the  Association  by  Dr.  Stille  and 
one  by  Dr.  Bush  are  given  in  this  volume. 


PHILADELPHIA  HOSPITAL  MEDICAL  SOCIETY. 

The  resident  physicians  on  duty  at  the  hospital  in  1886,  organ- 
ized a  society  for  the  advancement  of  medical  science,  and  the 
promotion  of  good  fellowship  among  the  resident  physicians  of 
the  hospital.  It  is  called  the  Philadelphia  Hospital  Medical 
Society.  Its  meetings  are  held  every  Wednesday  evening  at  9 
p.m.  The  programme  includes :  1.  Minutes;  2.  Reading  of  for- 
mal papers  and  discussion  of  same;  3.  Reports  of  cases  by  mem- 
bers; 4.  Business.  Once  a  month  a  physician  not  a  member, 
addresses  the  society  by  invitation.  At  each  meeting  some  mem- 
ber appointed  for  the  purpose  gives  an  epitome  of  recent  medical 
literature. 


CHILDREN'S   ASYLUM. 

A  few  notes  with  reference  to  this  asylum  have  been  received 
from  Dr.  W.  H.  Wallace,  formerly  superintendent  of  the  insane 
department  of  the  hospital,  and  now  in  charge  of  the  Mary 
Shields'  almshouse  fund: 

According  to  these  its  first  location  was  on  Fifth  street,  between  Pine  and  Federal 
streets,  at  the  house  of  Joseph  J.  Wharton.  This  property  was  afterwards  pur- 
chased by  the  guardians  of  the  poor.  Among  the  earliest  physicians  were  Drs. 
J.  G.  Nancrede,  William  Price,  Benjamin  Coates,  and  C.  D.  Skerritt.     In  1835, 


HISTORY  AND  ORGANIZATION  OF  THE  PHILADELPHIA  HOSPITAL.      129 

Joshua  M.  Wallace  was  elected  resident  physician  to  the  asylum.  The  obstetric- 
ians Avere  also  required  to  attend  the  asylum,  but  in  April,  1835,  Dr.  JT.  L.  Hodge, 
then  obstetrician  to  the  hospital,  declined  longer  to  attend  the  children,  and  a 
visiting  physician  was  appointed  for  the  asylum,  with  an  assistant,  who  had  to  be 
a  graduate  and  resident  of  the  house.  He  recommended  other  important  changes 
such  as  better  nurses,  and  more  conveniences  for  the  rooms,  which  would  be  calcu- 
lated to  diminish  the  mortality  of  the  children,  which  had  been  great.  April, 
1835,  twenty  children  had  died  of  measles  and  sore  mouth.  The  recommendations 
of  Dr.  Hodge  were  acceded  to  and  a  former  resident  student,  Dr.  Anderson,  was 
appointed  physician  to  the  asylum  with  a  salary  of  $200.  He  was  required  to  visit 
the  asylum  daily,  and  Dr.  J.  M.  Wallace  was  also  elected  resident  physician  ; 
both  were  appointed  on  trial  for  one  month. 

The  original  asylum  was  sold  in  1835,  and  the  children  were  removed  to  the 
institution  west  of  the  Schuylkill.  When  they  were  first  brought  to  the  new  alms- 
house they  were  placed  in  the  east  end  of  the  northwestern  range  of  buildings. 
In  1884,  the  asylum  was  removed  to  the  old  farm  house  on  the  east  side  of  the 
present  Thirty-fourth  street,  where  it  is  at  present  located. 

Among  other  resident  physicians  in  1836,  was  Dr.  Alfred  Stille,  who,  in  his  in- 
teresting reminiscences  published  in  this  volume,  makes  some  references  to  his 
experiences  in  the  children's  asylum. 

In  the  rules  of  the  guardians  for  1828,  is  given  a  statement  of  the  duties  of  the 
committee  of  the  children's  asylum.  This  committee  consisted  of  four  members, 
two  from  the  city  and  two  from  the  districts.  They  were  to  meet  "on  the  fourth 
day,  called  Wednesday"  ;  they  were  to  authorize  the  purchase  of  all  the  articles  ; 
were  required  to  examine  into  the  state  of  the  institution,  and  to  transact  such 
business  as  might  be  necessary  for  the  comfort  of  the  children.  They  were  also 
required  to  keep  record  of  all  asking  admission,  and  of  all  children  received  into 
the  department,  whether  from  the  city  or  from  the  districts,  also  the  names  of  the 
visitors,  and  a  list  of  deaths,  discharges,  or  elopements  of  children.  The  commit- 
tee met  monthly.  On  the  fourth  Monday  in  May  of  each  year  they  reported  to 
the  board  of  guardians  the  bills  for  supplies,  but  before  presentation  they  were 
required  to  be  signed  and  certified  to  by  the  matron.  The  published  rules  for  1861, 
1844  and  other  years,  were  materially  the  same  as  those  for  1828. 

In  connection  with  the  administration  of  the  almshouse  is  an 
office  known  as  visitor  of  children,  the  duties  of  which  are 
largely  concerned  with  the  children's  asylum.  The  rules  which 
govern  the  administration  of  this  office  are  to  be  found  in  copies 
of  the  printed  rules  published  at  different  times,  as  in  1861,  1864, 
1884,  1890.     This  office  at  present  is  filled  by  Mr.  Geo.  Milliken. 

The  visitor  sees  to  all  children  coming  under  the  care  of  the 
department  of  charities  and  correction  whether  admitted  into  the 
children's  asylum  or  not.  It  is  his  duty  to  see  that  no  child  over 
two  years  of  age  remains  in  the  house  for  a  longer  period  than 
permitted  by  act  of  assembly. 

It  is  also  his  duty  to  see  that  the  children  are  bound  out  to 
families  or  institutions,  and  to  see  that  they  are  cared  for  properly. 
9 


130      HISTORY  AND  ORGANIZATION  OF  THE  PHILADELPHIA  HOSPITAL. 

In  case  of  application  for  children  to  be  placed  out,  he  makes 
careful  investigation  into  the  character,  home  and  surroundings 
of  the  applicant;  he  sends  the  children  out  on  trial  and  reports  to 
the  board  of  charities  and  correction  any  unfair  or  unkind  treat- 
ment to  the  children  that  have  been  bound  out.  He  is  required 
to  report  to  the  board  from  time  to  time  and  also  to  present  a 
report  of  his  work  to  the  department. 


THE  INSANE  DEPARTMENT. 

Prior  to  1859,  as  stated  by  Dr.  Agnew,  the  insane  department 
of  the  Philadelphia  Hospital  was  not  in  an  organized  condition, 
although  in  1849,  Dr.  Henley  was  appointed  assistant  physician 
to  take  charge  of  the  insane,  and  also  of  the  smallpox  hospital. 
In  1852,  he  was  succeeded  by  Dr.  Benton,  but  was  reappointed 
in  a  short  time.  In  1854,  the  office  was  abolished  and  the  insane 
were  under  no  one  in  particular  until  the  selection  of  Dr.  J.  W. 
Butler,  in  1861.  From  this  time  however,  they  have  received  es- 
pecial attention,  and  at  a  meeting  of  the  board  of  guardians, 
November  18,  1861,  a  resolution  was  passed  that  the  part  of  the 
almshouse  containing  the  insane  be  called  the  Insane  Department 
of  the  Philadelphia  Hospital.  It  was  not  until  January  6,  1868, 
that  the  superintendent  of  the  insane  department  was  declared  to 
be  a  member  of  the  medical  board. 

In  November,  1866,  Dr.  Butler  was  succeeded  by  Dr.  D.  D. 
Richardson  who  served  steadily  from  this  time  to  September,  1880 
as  physician-in-chief,  when  Dr.  A.  A.  McDonald  was  elected  to 
succeed  him.  Dr.  Richardson  at  this  time  was  elected  superin- 
tendent of  the  State  Hospital  for  the  Insane,  at  Warren,  Penn- 
sylvania; he  was  recalled  to  Blockley  in  1881,  Dr.  McDonald 
having  resigned.  In  1885,  he  was  succeeded  as  physician-in-chief 
by  Dr.  Philip  Leidy. 

On  May  26,  1884,  the  committee  on  the  insane  department  of  the  board  of  guar- 
dians, recommended  the  appointment  of  consulting  physicians  to  the  department, 
whose  duty  it  should  be  in  connection  with  the  resident  physician-in-chief  to  make 
personal  examination  of  the  patients,  and  to  report  to  the  board  making  such  re- 
commendations as  should  be  declared  expedient.  It  was  also  further  suggested 
that  the  medical  staff  should  in  no  way  be  connected  with  the  insane  department. 
This  was  the  initiation  of  the  movement  for  the  appointment  of  a  consulting  staff. 

The  first  appointments  of  consulting  physicians  made  December  29,  1884,  were 
Drs.  S.  Weir  Mitchell,  Horatio  C.  Wood,  and  Charles  K.  Mills. 


HISTORY  AND  ORGANIZATION  OF  THE  PHILADELPHIA  HOSPITAL.      131 

In  1885,  Dr.  Wood  was  succeeded  by  Dr.  Andrew  Nebinger.  Dr.  Andrew  Neb- 
inger  died  on  April  26,  1886,  before  baving  an  opportunity  of  making  use  of  his 
position  for  the  benefit  of  the  hospital.  Dr.  James  A.  Simpson  was  elected  in  place 
of  Dr.  Nebinger. 

December  27,  1886,  Dr.  S.  Weir  Mitchell  resigned  from  the  staff,  and  a  vote  oi 
thanks  was  tendered  to  him  for  his  valuable  services.  At  the  same  meeting  at 
which  Dr.  Mitchell's  resignation  was  presented  and  accepted,  the  consulting  staff 
submitted  a  report,  calling  attention  to  the  over-crowding  and  to  the.need  of  more 
attendants,  and  the  desirability  of  more  trained  nurses  who  had  been  systemati- 
callj-  instructed  in  the  work  of  the  department.  Dr.  Mitchell  was  succeeded  as 
consultant  by  Dr.  Philip  Leidy,  who  resigned  about  the  same  time  as  physician- 
in-chief. 

Early  in  1887,  Dr.  William  H.  Wallace  was  elected  physician-in-chief  of  the 
department.  Dr.  Wallace  continued  to  hold  the  position  for  a  few  months  only, 
Drs.  Mills,  Simpson  and  Leidy  acting  as  consultants,  until  the  hospital  was  reor- 
ganized under  the  administration  of  the  new  board  of  charities  and  correction,  in 
April,  1887.  At  this  time  the  neurological  depaitment  was  enlarged  to  include 
both  wards  for  diseases  of  the  nervous  system  and  the  insane  department.  The 
position  of  physician-iu-chief  to  the  insane  department  as  a  separate  office  wTas 
abolished,  and  the  chief  resident  physician  of  the  hospital  was  also  made  chief  of 
the  insane  department.  The  neurological  staff  which  at  the  time  of  the  change 
consisted  of  Drs.  Mills  and  Bartholow,  was  increased  to  four,  namely,  Drs.  C  K. 
Mills,  H.  C.  Wood,  F.  X.  Dercum  and  Roberts  Bartholow. 

In  January,  1888,  Dr.  Bartholow  resigned  and  Dr.  James  Hendrie  Lloyd  was  elec- 
ted in  his  place.  During  the  same  year  Dr.  H.  C.  Wood  resigned  and  Dr.  Wharton 
Sinkler  was  his  successor.  In  December,  1889,  Dr.  C.  S.  Bradfute  was  elected  a 
member-  of  the  staff  in  place  of  Dr.  Lloyd.  Dr.  Bradfute  resigned  in  the  fall  of 
1890,  and  Dr.  Lloyd  was  reappointed. 

During  the  year  1890  the  rules  with  reference  to  the  organiza- 
tion of  the  insane  department  were  again  changed.  The  chief 
resident  physician  of  the  general  hospital  continued  to  act  as 
physician-in- chief  of  the  insane  department,  but  the  neurological 
staff  of  the  hospital  was  made  a  consulting  instead  of  a  visiting 
staff  to  the  insane  department. 

The  insane  department  has  experienced  several  great  catas- 
trophies.  The  two  most  remarkable  of  these  were  the  falling  in 
of  a  wall  and  a  series  of  arches  July  20,  1864,  and  the  great  fire 
which  occurred  on  the  evening  of  February  12,  1885.  Both  re- 
resulted  in  serious  loss  of  life. 

At  the  meeting  of  the  board  of  guardians,  August  8,  1864,  a  long  communication 
was  presented  in  regard  to  the  catastrophe,  condemning  the  safety  of  the  building 
and  the  reckless  manner  in  which  alterations  were  made  in  1849.  The  department 
was  directed  to  be  examined  as  to  safety  by  competent  persons. 

Dr.  S.  W.  Butler,  the  superintendent  of  the  insane  department  in  his  report  to 
the  board  of  guardians  for  the  year  1864,  gives  a  clear  account  of  the  first  of  these 
accidents.     "At  a  little  before  six  o'clock  in  the  morning  of  the  20th  of  July,  the 


132      HISTORY  AND  ORGANIZATION  OF  THE  PHILADELPHIA  HOSPITAL. 

foundation  of  a  pier  which  was  the  central  support  of  a  series  of  arches,  a  chimney 
stuck  and  walls  on  which  rested  the  joists  of  the  second,  third  and  attic  stories  of  a 
tier  of  wards,  gave  way,  and  without  the  slightest  warning  the  whole  division  Avail 
and  chimney  stack  fell  with  a  crash  burying  many  of  the  patients  in  the  ruins. 
Of  these  fifteen  were  killed  outright  or  died  soon  after  they  were  extricated,  and 
twenty-five  were  more  or  less  severely  injured,  of  whom  two  subsequently  died.'' 

The  terrible  fire  in  the  insane  department,  still  fresh  in  the 
memory  of  the  community,  broke  out  at  eight  o'clock  on  the 
evening  of  February  12,  1885.  Official  investigation  made  later 
seemed  to  demonstrate  that  it  was  the  act  of  a  half  witted  or  im- 
becile patient.  Eighteen  lost  their  lives  in  this  fire;  seven  of 
these  died  from  suffocation  and  eleven  from  burns  and  various 
injuries.  A  more  than  equal  number  were  wounded,  many  of 
them  seriously,  and  a  large  number  of  missing  were  reported. 

Much  that  was  interesting  for  the  medical  history  of  this  institution  occurred  in 
consequence  of  this  fire.  Only  a  few  weeks  before  its  occurrence,  the  consulting 
physicians  to  the  insane  department,  Drs.  Mitchell,  Wood  and  Mills  had  clearly 
indicated  the  deadly  peril  from  hre  to  which  the  institution  and  its  iumates  were 
constantly  subjected  After  the  fire  many  consultations  were  held  between  city 
councils  or  its  committees,  the  board  of  guardians,  the  board  of  public  charities, 
the  consulting  staff  of  the  insane  department,  and  members  of  the  medical  board, 
with  the  view  not  only  of  providing  temporarily  for  the  unhoused  inmates  of  the 
hospital,  but  also  to  determine  whether  some  measures  of  permanent  value  could 
not  be  taken  for  the  relief  both  of  the  insane  and  sick  poor  at  Blockley.  Many  of 
the  patients  were  distributed  to  the  various  state  hospitals  ;  and  many  of  the  out- 
warders  were  sent  temporarily  to  the  house  of  correction,  their  places  being  taken 
by  the  insane  who  were  still  kept  at  the  institution.  The  whole  of  the  department 
with  the  exception  of  the  two  west  wings,  was  destroyed  by  fire.  In  a  short  time 
these  wings  were  put  in  condition  for  the  reception  of  patients. 


PATHOLOGICAL  DEPARTMENT. 

Dr.  Agnew  has  briefly  recorded  a  few  facts  with  reference  to 
the  museum  and  pathological  department  of  the  hospital.  As 
early  as  November  25,  1814,  an  effort  was  made  to  establish  a 
hospital  museum,  and  a  few  specimens  were  collected;  in  1840, 
a  building  was  set  aside  for  a  museum,  but  nothing  practical  was 
done  until  1860,  when  a  resolution  was  passed  by  the  board  of 
guardians  to  found  a  pathological  museum,  and  in  1861,  Dr. 
Agnew  was  appointed  curator. 


HISTORY  AND  ORGANIZATION  OF  THE  PHILADELPHIA  HOSPITAL,     ldo 

Work  was  begun  by  him  and  was  carried  on  with  decided 
practical  results,  as  may  be  seen  by  consulting  the  printed  An- 
nual Statements  of  the  board  of  guardians.  In  the  Report  or 
Annual  Statement  of  the  board  for  the  year  ending  December  31, 
1864,  for  example,  Dr.  Agnew  gives  a  list  of  the  morbid  specimens 
which  comprised  the  contents  of  the  pathological  museum  at  that 
time.  This  list  contains  107  prepared  sj^ecirnens,  the  names  of 
which  are  given,  most  of  them  evidently  of  value  for  clinical  and 
pathological  teaching.  He  also  gives  in  the  same  volume  another 
list  of  14  specimens  in  process  of  preparation  for  mounting. 

On  April,  1866,  an  effort  was  made  to  add  a  microscopist  to  the  staff  of  the  hos- 
pital. At  a  meeting  of  the  board  of  guardians,  April  16,  1866,  a  communication, 
which  had  been  made  to  the  hospital  committee  of  the  board,  was  presented  from 
Dr.  Charles  P.  Tutt,  one  of  the  attending  physicians.  Dr.  Tutt  referred  to  the  fact 
that  his  duties  as  attending  physician  occupied  so  much  of  his  time,  that  he  was 
unable  to  make  microscopical  examinations  of  the  structures  found  or  supposed  to 
be  diseased  at  the  autopsies,  which  should  be  done  to  complete  the  history  of  the 
cases.  He  requested  to  be  allowed  to  invite  Dr.  James  Tyson  to  make  such  exam- 
inations for  the  hospital,  and  also,  in  consideration  for  his  services  that  Dr.  Tyson 
should  be  permitted  to  give  a  course  of  lectures  on  the  microscope  in  the  lecture 
room  of  the  hospital.  At  the  same  meeting  of  the  board  of  guardians,  a  communi- 
cation was  "signed  by  Drs.  F.  F.  Maury,  Alfred  Stille,  W.  H.  Pancoast,  and  other 
members  of  the  medical  board  and  presented,  recommending  Dr.  Tyson  for  the 
position  of  microscopist.  Dr.  Agnew  also  sent  a  letter  to  the  board  strongly  com- 
mending the  project  and  advocating  the  election  of  Dr.  Tyson.  These  communi- 
cations were  referred  to  the  hospital  committee,  with  instructions  to  report  at  the 
next  meeting  and  on  May  14,  1866,  this  committee  reported  in  favor  of  appointing 
a  microscopist,  whose  duty  it  should  be  to  prepare  a  written  account  of  such  sub- 
jects as  might  be  required  by  the  attending  physician.  The  committee  also 
reported  in  favor  of  the  microscopist  having  the  use  of  the  lecture  room  for  his 
course  of  lectures.  The  report  and  resolutions  were  agreed  to,  and  Dr.  Tyson  was 
elected  microscopist.     Dr.  Aguew  still  continued  curator. 

In  the  Annual  Statement  of  the  board  of  guardians  for  the  year  ending  December 
31,  1867,  appears  the  first  report  of  Dr.  Tyson  as  microscopist.  He  speaks  of 
reports  on  the  various  subjects  having  been  prepared,  with  drawings  in  many 
of  the  cases.  These  reports  made  in  1866  and  1867  were  seven  in  number,  and  from 
their  titles  Avere  evidently  of  great  practical  interest. 

On  October  14,  1867,  Dr.  Agnew  resigned  as  curator,  and,  at 
the  same  meeting,  Dr.  William  Pepper  was  elected  in  his  place. 
Dr.  Tyson  continued  to  hold  the  position  of  microscopist  until 
January  22,  1872,  when  he  resigned  and  on  February  26,  1872, 
Dr.  R.  M.  Bertolet  was  chosen  for  the  vacant  position.  Novem- 
ber 22,  1871,  Dr.  Pepper  resigned  as  curator,  and  Dr.  Tyson  was 
appointed  curator  and  pathologist,     For  a  time  be  held  the  two 


134     HISTORY  AND  ORGANIZATION  OF  THE  PHILADELPHIA  HOSPITAL. 

positions  of  curator  and  microscopist,  until  as  stated,  Dr.  Bertolet 
succeeded  him  in  the  latter  office.  In  March,  1872,  Dr.  Tyson 
was  elected  one  of  the  visiting  physicians  of  the  hospital,  but 
continued  also  as  curator  and  pathologist  until  1875. 

In  1871,  a  catalogue  of  the  specimens  in  the  pathological  museum  was  prepared 
conjointly  by  Drs.  Tyson  and  Bertolet.  This  catalogue  was  prepared  under  un- 
usual difficulties,  as  no  attempt  had  been  previously  made  to  arrauge,  label  and 
catalogue  the  specimens,  some  of  which  had  been  in  the  museum  for  years,  while 
the  nature  of  them  had  to  be  determined  if  possible  without  unsealing  the  jars  or 
unmounting  them.  The  total  number  of  specimens  was  322,  as  follows  :  Osseous 
71  ;  nervous  14  ;  integumentary  and  connective  tissue  4  ;  digestive  apparatus  71  ; 
respiratory  26  ;  vascular  44 ;  genito-urinary  70  ;  unclassified  tumors.  7  ;  calculus, 
concretions,  etc.,  7. 

In  later  years  the  valuable  museum  of  the  institution  was  allowed  to  degenerate, 
and  most  of  the  specimens  mysteriously  faded  out  of  sight,  but  within  a  few 
years  interest  has  been  revived  and  many  valuable  specimens  have  been  collected 
for  the  reorganization  of  the  museum. 

In  the  Annual  Statement  of  the  board  of  guardians  for  the  year  ending  Decem- 
ber 31,  1875,  the  name  of  Dr.  Thomas  B.  Reed  appears  for  the  first  time  as  micro- 
scopist. Dr.  Bertolet  during  the  same  year  had  succeeded  Dr.  Tyson  as  curator.  In 
1876,  Dr.  Joseph  Berens  was  appointed  curator  and  pathologist,  and  the  position 
of  microscopist  was  apparently  not  filled.     Dr.  Berens  continued  until  1879. 

In  1880,  Dr.  E.  O.  Shakespeare,  already  ophthalmologist  to  the  hospital,  was 
made  curator,  and  Dr.  H.  F.  Formad  was  appointed  microscopist.  Each  of  these 
gentlemen  remained  in  these  respective  positions  for  several  years.  On  October  30, 
1882,  however,  Dr.  Shak<  speare  was  made  pathologist,  the  office  of  curator  appar- 
ently disappearing  as  a  separate  position.  Dr.  Formad  continued  microscopist  in 
1882,  1883,  1884,  1885  and  1886.  In  1887  Drs.  Shakespeare  and  P"ormad  were  both 
appointed  pathologists  and  were  assigned  duty  at  different  times,  each  taking  half 
the  jrear.  In  December,  1889,  Dr.  Formad  was  appointed  pathologist,  and  Drs. 
J.  Leffingwell  Hatch  and  H.  W.  Cattell,  assistant  pathologists.  At  the  same 
meeting  the  position  of  bacteriologist  was  created  and  to  it  Dr.  Shakespeare  was 
appointed. 

According  to  the  rules  of  1890,  the  bacteriologist  has  charge,  as  a  laboratory,  of 
the  upper  floor  of  the  dead  house,  except  the  north-east  room.  It  is  his  duty  to 
make  investigations  of  infectious  diseases  in  the  hospital  (using  the  hypodermic 
needle  on  the  cadaver  if  necessary)  and  of  hygienic  questions  which  may  be  sub- 
mitted to  him  by  the  bureau  of  charities  or  the  medical  staff.  He  serves  without 
compensation,  and  acting  with  the  sanction  of  the  bureau  and  superintendent,  can 
procure  all  the  supplies  necessary  for  the  proper  carrying  out  of  his  investigations, 
the  cost  of  such  supplies  to  be  charged  to  the  pathological  item. 

The  first  classes  instructed  directly  in  pathology  at  the  Phila- 
delphia Hospital  were  taught  by  Dr.  J.  Pendleton  Tutt  in  1865. 
Dr.  Tutt,  who  died  of  typhoid  fever  contracted  in  the  hospital, 
was  a  man  of  great  energy,  an  indefatigable  worker,  thoroughly 
imbued  with  a  scientific  spirit.     Dr.  Tyson  first  taught  classes  in 


HISTORY  AND  ORGANIZATION  OP  THE  PHILADELPHIA  HOSPITAL.     135 

microscopical  and  pathological  histology  in  the  spring  of  1871. 
Since  this  time  many  classes  have  been  taught  not  only  by  the 
curator,  mocroscopist  and  pathologist,  but  by  various  members  of 
the  attending  staff.  Dr.  Form  ad  has  for  many  years  given  in- 
structions in  the  hospital  to  the  students  of  the  University  of 
Pennsylvania.  It  would  be  hard  to  estimate  how  much  the  path- 
ological department  of  this  hospital  has  done  for  the  students  of 
medicine,  and  through  the  presentation  of  specimens  at  societies, 
for  the  profession  at  large. 

The  resident  physicians  of  the  Philadelphia  Hospital  have 
long  been  recognized  as  among  the  best  equipped  men  in  the 
profession,  particularly  with  reference  to  gross  pathological  work, 
and  their  frequent  opportunities  of  making  post-mortem  exami- 
nations under  competent  physicians  and  pathologists  have  helped 
to  give  them  this  enviable  reputation. 


NEUROLOGICAL  DEPARTMENT. 

The  neurological  department  of  the  hospital,  which  has  now 
become  co-extensive  with  the  other  great  departments,  had  a 
slender  beginning  in  1877.  Dr.  Mills  was  appointed  neurolo- 
gist to  the  hospital  and  proceeded  to  establish  a  nervous  depart- 
ment. The  outwards  were  full  of  the  richest  material  for  the  study 
of  organic  nervous  diseases. 

The  wards  for  nervous  diseases  were  started  in  trie  old  wooden  pavilions  in 
the  clinic  yard.  The  numher  of  patients  at  first  was  limited,  and  these  were 
collected  hy  Dr.  Mills  from  the  outwards,  picking  up  here  and  there  a  case  of 
hemiplegia,  of  sclerosis,  or  of  some  other  form  of  organic  nervous  disease.  Many 
such  patients,  in  a  deplorable  condition  were  found,  some  of  them  in  the  cubbies 
or  blind  rooms.  In  the  third-story  of  the  men's  outwards  was  also  a  room  known 
as  the  ' '  paralytic  ward, ' '  in  which  were  collected  a  number  of  helpless  patients. 
This  ward  was  included  under  the  care  of  the  neurologist,  and  after  a  long  time 
its  occupants  were  transferred  to  the  pavilions.  Gradually  patients,  both  male  and 
female,  were  added  to  the  limited  numbers  first  placed  in  the  nervous  wards,  and 
as  several  of  the  pavilions  were  at  that  time  unoccupied,  no  limit  was  put  to  the 
growth  of  the  wards,  until  in  1890  the  number  of  patients  had  reached  two  hun- 
dred and  fifty  or  more. 

The  first  arrangement  was,  that  Dr.  Mills  should  have  charge  of  one- half  of 
the  whole  number  of  patients  admitted  to  the  nervous  .wards,  the  care  of  the  other 
half  being  distributed  pro  rata  among  the  members  of  the  medical  staff  on  duty. 
In  1883,  Dr.  H.  C.  Wood  was  made  an  additional  neurologist  ;  and  Drs.  Mills  and 
Wood  remained  in  charge  of  the  wards  until  1887,  when  Dr.  Roberts  Bartholow 
was  elected  to  succeed  Dr.  Wood.     In  1887,  the  neurological  department  was  re- 


136      HISTORY  AND. ORGANIZATION  OP  THE  PHILADELPHIA  HOSPITAL. 

organized  upon  a  new  basis,  and  its  staff  was  now  increased  to  four — Drs.  Mills, 
Wood,  Bartholow  and  Dercum.  In  January,  1888,  Dr.  Bartholow  resigned,  and 
Dr.  James  Hendrie  Lloyd  was  chosen  for  the  vacancy  ;  later,  in  1888,  Dr.  Wood 
also  resigned,  and  Dr.  Wharton  Sinkler  was  elected  to  his  place.  When  numer- 
ous changes  were  made  in  the  medical  board  at  the  election  in  December,  1889, 
Drs.  Mills,  Dercum  and  Sinkler  were  re-elected,  and  Dr.  C.  B.  Bradfute  was  added 
to  the  staff  in  place  of  Dr.  Lloyd.  In. the  autumn  of  1890,  Dr.  Bradfute  resigned, 
and  in  December,  Dr.  Lloyd  was  re-appointed  to  his  former  position  on  the  staff. 

When  the  re-organization  of  the  nervous  department  took  place  in  1887,  the  entire 
insane  department  was  included  in  its  jurisdiction,  the  neurologists  being  also  made 
visiting  physicians  to  the  insane  department.  This  arrangement  continued  until 
1890,  when  the  neurologists  continuing  in  charge  of  the  nervous  wards,  were  made 
consulting  instead  of  visiting  physicians  to  the  insane  department. 

The  brick  pavilions  occupied  by  the  men's  nervous  wards,  are  among  the  cleanest, 
best  lighted  and  ventilated  in  the  entire  hospital,  a  striking  contrast  to  the  original 
quarters  of  this  department.  At  one  end  of  one  of  the  pavilions  a  large  room  has 
been  partitioned  off  to  serve  as  a  laboratory  and  ward  lecture-room,  and  in  it  lectures 
are  frequently  given  to  small  classes.  It  is  also  used  for  electrical  and  other  forms 
of  treatment,  as  suspension,  the  application  of  plaster  jackets,  massage  and  Swedish 
movements. 

Possibly  no  hospital  in  the  world  has  better  facilities  for  the  study  of  organic 
nervous  disease  and  insanity  than  are  to  be  found  in  this  department,  which  has 
been  the  fountain  from  which  has  issued  much  of  the  literature  supplied  by  Phila- 
delphians  to  neurology.  Clinical  lectures  on  nervous  diseases  were  about  1878 
assigned  to  the  neurologists  for  three  months  in  the  year,  in  the  regular  medical 
hour  on  Wednesday  and  Saturday,  and  such  lectures  have  been  delivered  ever 
since.  In  addition,  many  classes  from  the  University  of  Pennsylvania,  the  Phila- 
delphia Polyclinic,  and  other  institutions  have  been  instructed  in  the  nervous  wards 
by  various  members  of  the  staff. 

One  after  another,  as  stated  in  the  historical  memoranda  of  the  almshouse,  the 
wooden  pavilions  were  torn  down,  the  first  in  1884,  when  the  women's  nervous 
wards  were  removed  to  the  lower  floor  of  the  women's  outwards. 


OPHTHALMOLOGICAL  DEPARTMENT.1 

In  the  Annual  Statement  of  the  guardians  for  the  fiscal  year 
ending  December  31,  1861,  the  first  synopsis  of  the  ward  reports 
may  be  found.  In  this  classification  there  is  no  mention  of  sepa- 
rate wards  for  either  eye  or  skin  diseases.  In  the  Annual  State- 
ment for  1862,  Dr.  J.  L.  Ludlow,  secretary  of  the  medical  board 
reports  that  in  the  eye  ward,  99  were  treated,  31  cured,  47  relieved, 
and  no  deaths.  The  attending  staff  of  the  hospital  was  at  this 
time  divided  into  surgeons,  physicians  and  accoucheurs.  Among 
the  surgeons  were  Drs.  Samuel  Gross,  D.  Hayes  Agnew,  R.  J. 

1  Notes  on  the  ophthalmological  and  dermatological  departments  were  furnished  by  Dr. 
G.  E.  deSehweinitz. 


HISTORY  AND  ORGANIZATION  OP  THE  PHILADELPHIA  HOSPITAL.      137 

Levis  and  R.  S.  Kenderdine,  and  the  duty  of  attending  to  the 
cases  admitted  for  diseases  of  the  skin  and  eye  devolved  upon 
these  members  of  the  staff.  In  1863,  fifty-seven  cases  were  admit- 
ted, and  severity -three  treated  in  the  eye  ward.  After  this  date 
the  reports  are  fuller,  and  contain  each  year  tables  indicating  the 
various  surgical  and  medical  affections  which  come  under  treat- 
ment, the  eye  and  skin  diseases  respectively  comprising  a  table. 

In  1877,  Dr.  E.  0.  Shakespeare  was  elected  ophthalmologist.  Previous  to  that 
time  there  was  no  special  eye  service  in  the  hospital,  although  a  separate  ward  for 
diseases  of  the  eye  existed  for  men  and  women.  During  the  year,  111  cases  were  treated 
in  the  men's  eye  ward  ;  mention  is  not  made,  however,  in  the  classification  whether 
separate  wards  were  used  for  women,  although  this  is  known  to  have  heen  the  case. 
This  separate  classification  does  not  appear  to  have  been  considered  in  the  reports 
until  1878,  when  the  sexes  were  divided.  Before  the  election  of  Dr.  Shakespeare, 
by  common  consent  of  those  on  duty,  Dr.  William  Pancoast  had  treated  all  dis- 
eases of  the  eye.  From  1887,  when  the  eye  department  as  a  special  and  independent 
service  was  created,  Dr.  Shakespeare  remained  on  duty,  having  the  sole  charge  of 
this  department  until  June,  1887,  when  an  additional  ophthalmological  position 
was  created,  and  Dr.  G.  E.  deSchweinitz  elected  as  ophthalmologist.  From  1887 
to  December,  1889,  during  several  prolonged  absences  of  Dr.  Shakespeare,  his  duties 
were  performed  by  different  members  of  the  visiting  surgical  staff  on  duty  at  the 
time.  In  the  summer  of  1888,  this  work  devolved  especially  upon  Dr.  Charles 
Hermon  Thomas. 

The  men's  eye  ward  was  originally  situated  on  the  second  floor  of  the  main 
building  next  to  the  venereal  ward,  and  continued  to  occupy  this  floor  until  the 
wooden  pavilions,  formerly  occupied  by  nervous  patients,  were  torn  down,  and 
the  new  brick  structures,  which  have  taken  their  places,  were  erected.  The 
second  floor  of  the  first  building  was  carefully  constructed  for  the  purposes  of  an 
eye  ward,  and  the  transfer  made  during  November,  1888.  This  ward  consists  of  a 
long  room  containing  thirty-two  beds,  lighted  by  windows  covered  in  by  a  movable 
curtain,  whose  adjustment  suitably  regulates  the  amount  of  light.  At  the  western 
end  of  the  ward,  in  addition  to  hot  and  cold  water,  bath-room  attachments,  closets 
for  medicines,  dressings,  etc.,  is  a  large  dark  room,  especially  arranged  for  ophthal- 
moscopic purposes.  The  near  proximity  of  this  dark  room  to  the  nervous  wards 
below  and  to  the  southern  side  of  it,  rendersthe  study  of  medical  ophthalmology 
easy  of  execution.  In  addition  to  the  facilities  afforded  by  the  new  ward  for  the 
treatment  of  various  eye  diseases,  either  end  of  it  can  be  screened,  and  affords  an 
excellent  operating  room,  sufficient  steady  northern  light  being  readily  accessible 
through  the  high  windows. 

The  women's  eye  ward  has  always  been  on  the  women's  surgical  floor.  In  1886, 
it  occupied  ward  4,  and  was  divided  by  a  partition  into  two  apartments  for  white 
and  colored  patients  respectively.  In  1887,  the  occupants  were  moved  into  the 
present  women's  surgical  dining  room,  and  in  the  latter  part  of  the  same  year,  or 
early  in  1888,  they  were  transferred  into  the  present  children's  ward.  In  Novem- 
ber, 1888,  the  cases  were  once  more  moved  to  the  quarters  which  they  now  occupy, 
namely  :  ward  4  on  the  women's  surgical  floor.  This  has  been  especially  pre- 
pared for  the  reception  of  eye  cases,  the  windows  and  doors  having  been  curtained 
to  regulate  the  light.     At  the  present  time,  in  addition  to  the  eye  cases,  one-half 


138     HISTORY  AND  ORGANIZATION  OF  THE  PHILADELPHIA  HOSPITAL. 

the  ward  is  devoted  to  the  reception  of  patients  suffering  froni  diseases  of  the  skin. 
From  June,  1887,  to  December,  1889,  Dr.  Shakespeare  and  Dr.  de  Schweinitz 
were  the  ophthalmologists  of  the  hospital,  each  serving  alternate  terms  of  three 
months.  In  December,  1889,  Dr.  Shakespeare  was  succeeded  by  Dr.  G.  M.  Gould. 
Dr.  Shakespeare  was  appointed  bacteriologist.  Since  this  date,  Dr.  de  Schweinitz 
and  Dr.  Gould  have  continued  as  the  ophthalmologists,  serving,  as  was  before  the 
case,  alternate  terms  of  three  months  each. 


DERMATOLOGIOAL  DEPARTMENT. 

Previous  to  1887,  there  was  no  special  dermatological  service, 
but  cases  in  the  skin  ward,  as  those  of  the  eye  ward,  were 
apportioned  to  the  members  of  the  visiting  staff.  In  1870,  the 
late  Dr.  Maury  had  charge  of  this  ward,  and  from  that  date  to 
1877  Dr.  Duhring  was  practically  in  charge,  becoming  full  der- 
matologist in  that  year  by  election  by  the  board  of  guardians. 
Dr.  Duhring  continued  in  sole  charge  of  this  service  until  June, 
1887,  when  an  additional  dermatological  position  was  created,  and 
Dr.  Henry  W.  Stelwagon  was  chosen  to  conduct  the  service. 
From  this  time  Dr.  Duhring  and  Dr.  Stelwagon  were  the  der- 
matologists of  the  hospital  until  December,  1889,  when  Dr. 
Duhring  was  succeeded  by  Dr.  Cantrell. 

The  dermatological  cases  are  divided  according  to  the  sexes 
into  two  wards.  The  ward  for  the  male  patients  is  on  the  second 
floor  of  the  hospital  building,  and  the  quarters  are  those  which 
have  been  occupied  from  the  date  of  the  institution  of  this  service. 
The  diseases  of  the  skin  occurring  among  women  are  treated  in 
half  of  the  ward  on  the  women's  surgical  floor,  which  is  set  apart 
for  diseases  of  the  eye. 


LARYNGOLOGICAL  DEPARTMENT. 

On  February  24,  1890,  a  committee  reported  on  behalf  of  the 
medical  board  to  the  president  of  the  board  of  charities  and 
correction,  that  the  number  of  cases  needing  the  services  of  a 
specialist  in  throat  diseases  was  sufficiently  great  to  make  it  im- 
portant to  add  two  laryngologists  to  the  medical  staff.  Shortly 
afterwards  Drs.  C.  Jay  Seltzer  and  George  Morley  Marshall  were 
appointed  laryngologists. 


HISTORY  AND  ORGANIZATION  OP  THE  PHILADELPHIA  HOSPITAL.      139 
THE  MARY  SHIELDS'  ALMSHOUSE  FUND.1 

Mrs.  Mary  Shields,  who  died  October  8,  1880,  bequeathed  to 
the  city  of  Philadelphia,  one  twelfth  part  of  her  estate  "to  relieve 
and  make  more  comfortable  the  sick  and  the  insane  poor  at  the 
almshouse  in  Philadelphia." 

In  November,  1883,  the  board  of  directors  of  city  trusts,  after 
conferring  with  the  board  of  guardians  of  the  poor,  adopted  a  plan 
and  regulations  for  the  disposal  of  the  fund.  This  plan  required  the 
appointment  of  "  a  physician  of  at  least  five  years  standing  "  to  be 
superintendent  of  the  "  Mary  Shields'  Almshouse  Fund,"  whose 
duty  it  should  be  to  visit  the  almshouse  frequently,  and  keep  him- 
self informed  with  regard  to  all  matters  relating  to  the  sick  and 
insane  poor,  to  communicate  as  necessary  with  the  guardians  of 
the  poor  and  their  officers  and  agents,  make  estimates  of  necessary 
expenditure,  etc.  Dr.  W.  H.  Wallace  was  appointed  to  this 
position. 

The  accumulated  income  was  applied  to  the  erection  of  anew 
kitchen  building  with  complete  cooking  apparatus  of  the  best 
character.  This  was  nearly  finished  at  the  time  of  the  disastrous 
fire  on  the  night  of  February  12,  1885,  after  which  the  work  was 
rapidly  pushed  and  completed. 

A  kitchen  was  built  and  furnished  for  the  general  hospital  in 
1886,  and  during  1890,  part  of  the  cost  of  a  third  kitchen  has  been 
paid. 

The  income  of  the  fund  has  been  used  to  supply,  as  far  as 
possible,  such  things  as  were  necessary  to  the  comfort  and  welfare 
of  the  patients,  but  which  were  not  furnished  in  the  usual  way 
by  the  hospital  authorities.  Some  of  the  articles  supplied  at 
various  times  have  been  an  organ,  a  piano,  banjos,  accordeons, 
etc.,  settees  and  lawn  seats,  large  water-coolers  for  the  wards, 
rocking  chairs,  a  large  number  of  autotype  engravings  (framed 
and  hung),  numerous  games  of  all  kinds — cards,  dominoes, 
checkers,  chess,  backgammon,  etc.,  for  indoor  use ;  patterns  and 
material  for  embroidery,  crocheting,  etc.,  for  female  patients ; 
and  for  outdoor  use  such  games  as  croquet,  lawn  tennis,  football. 

Subscriptions  are  made  annually  to  numerous  periodicals,  the  best  of  the  illus- 
trated monthly  and  weekly  publications,  a  total  amount  of  about  1100  numbers  per 
year,  and  distributed  to  the  patients.  A  carefully  selected  library,  suited  to  the 
needs  and  capacities  of  the  class  of  patients  for  whose  use  they  are  intended,  was 

1  Notes  furnished  by  Dr.  W.  H.  Wallace,  superintendent  of  the  fund. 


140     HISTORY  AND  ORGANIZATION  OP  THE  PHILADELPHIA  HOSPITAL. 

presented  to  the  insane  department,  and  to  it,  additions  have  since  been  made. 
Spectacles,  water,  and  air  beds,  air  cushions,  bed  rests  and  commodes  have  been 
supplied,  and  a  large  number  of  rolling  and  reclining  chairs  furnished  to  the  insane 
department  and  to  the  general  hospital. 

On  Christmas  day,  Thanksgiving  and  other  holidays,  additions  are  made  to  the 
diet  of  the  patients  in  the  department  for  the  insane,  and  occasional  treats  of  fresh 
fruit  in  season,  strawberries,  peaches,  apples,  watermelons,  bananas,  cranberries  ; 
turkey  and  mince  pie  for  Christmas  ;  turkey  and  pumpkin  pie  for  Thanksgiving  ; 
oysters  and  plum  pudding  for  Washington's  birthday  ;  lemons  for  the  sick  as 
required. 

The  general  meeting  room  or  entertainment  hall  was  furnished  with  a  large  stage 
and  furniture,  chairs,  tables,  etc.,  including  a  pulpit  for  religious  services  and  seats 
for  the  patients.  On  the  completion  of  this  on  January  1,  1890,  an  entertainment 
was  given,  including  a  punch  and  judy  show,  an  orchestral  concert,  etc.,  with  cake 
and  ice  cream. 


THE  TRAINING-SCHOOL  FOR  NURSES.1 

One  of  the  memorable  events  in  the  history  of  the  Phila- 
delphia Hospital  was  the  establishment  of  the  Training-School  for 
Nurses  by  Miss  Alice  Fisher,  and  her  friend  and  associate, 
Miss  Edith  Horner.  This  school  was  founded  in  the  autumn  of 
1884.  Mr.  Edward  F.  Hoffman,  president  of  the  board  of  guar- 
dians and  Mr.  R.  C.  McMurtrie,  Mr.  James  Stewart,  Dr.  Thomas 
Biddle,  Mr.  John  Huggard,  and  others,  were  earnest  and  ener- 
getic in  support  of  the  movement, 

At  the  stated  meeting  of  the  board  of  guardians,  September  24,  1883,  a  special 
committee  was  appointed  with  reference  to  a  proposed  training  school  for  nurses ; 

'Although  the  training-school  for  nurses  was  not  established  until  1884,  some  years  prior 
to  this  time  nurses  froni  the  training-school  of  the  Woman's  Hospital  of  Philadelphia  had 
served  at  several  periods  in  the  hospital  wards.  At  the  meeting  of  the  board  of  guardians. 
December  27,  1875,  the  managei'S  of  the  Woman's  Hos|3ital  appealed  to  the  board  to  set  apart 
one  of  the  wards  of  the  Philadelphia  Hospital  to  be  attended  by  a  corps  of  nurses  from  their 
school.  This  communication  was  at  first  laid  on  the  table,  but  subsequent  to  this  time  received 
favorable  consideration,  and  arrangements  were  made  to  give  six  months  of  the  novitiate  in- 
struction of  the  training-school  in  the  wards  of  the  Philadelphia  Hospital.  Some  interesting 
facts  in  regard  to  this  service  are  to  be  learned  from  the  Reports  of  the  Training-School  of  the 
Woman's  Hospital  for  1876-77-78. 

For  the  suggestion  that  prompted  this  action,  for  the  liberal  offer  of  assistance  that  alone 
made  it  possible  to  carry  out  the  plan,  the  managers  express  themselves  indebted  to  Mrs. 
Pauline  E.  Henry,  a  lady  of  Germantown,  deeply  interested  in  nurse  training.  Owing  to  un- 
expected delays  in  finishing  the  pavilions  of  the  hospital,  these  nurses  did  not  enter  into  active 
service  until  July  28,  1876,  when  an  efficient  corps  went  on  duty  under  the  supervision  of  a 
head  nurse  appointed  by  the  Woman's  Hospital,  subject  to  the  direction  of  the  physicians  in 
charge  at  the  Philadelphia  Hospital.  The  woman's  training-school  had  the  care  of  four  wards 
with  fifty  beds.  Of  the  class  of  1876,  Amanda  Taylor  acted  as  head  nurse ;  in  1877,  Ellen  Double- 
day  was  head  nurse. 


HISTORY  AND  ORGANIZATION  OF  THE  PHILADELPHIA  HOSPITAL.      141 

Mrs.  Harriet  L.  Clute  of  Blackwell's  Island,  N.  Y.,  training  .school,  was  invited 
to  visit  the  Philadelphia  Hospital,  and  it  was  recommended,  if  possible,  to  engage 
her  service-  to  establish  a  training  school  at  a  salary  not  exceeding  $1,000  per  annum. 
Tin-  effort  was  not  successful. ' 

At  the  meeting  April  8,  1884,  a  long  letter  was  read  from  the  hospital  committee 
on  the  subject  of  the  training  school  for  nurses.  The  object  designed  was  to  procure 
an  efficient  staff  of  competent  nurses:  a  head  nurse  was  desirable.  It  was  also 
important  that  the  vacancies  when  occurring  should  be  filled  by  suitable  persons, 
who  make  nursing  a  profession  and  occupation.  Experience  in  New  York  had 
shown  the  great  advantage  of  trained  nurses.  It  was  proposed  to  commence  witli 
twelve  young  women. 

Among  the  new  rules  adopted  at  the  stated  meeting.  March  :24.  1884,  was  one 
that  a  competent  and  Skilled  head  nurse  should  lie  appointed  to  have  charge  of  the 
nurses  and  attendants,  and  that  it  should  be  her  duty  to  have  competent  nurses  and 
attendants  under  her,  and  to  see  if  they  diligently  fulfilled  their  duties. 

July  28,  1SS4,  at  the  meeting  of  the  board  of  guardians,  the 
president,  Mr.  Hoffman,  stated  that  for  some  time  past  efforts 
had  been  made  to  find  a  suitable  person  for  head  nurse  of 
the  proposed'  training-school.  Mr.  George  W.  Chi  Ids  and  Mr. 
Anthony  Drexel  having  interested  themselves  in  the  matter,  had 
submitted  the  name  of  Miss  Alice  Fisher,  superintendent  of  the 
training-school  at  Birmingham.  England,  as  one  competent  to  fill 
the  position,  having  first-class  credentials  from  prominent  phy- 
sicians in  England.  Mr.  Stewart  offered  a  resolution,  which  was 
adopted,  that  the  thanks  of  the  board  be  tendered  to  Messrs. 
George  W.  Childs  and  Mr.  Anthony  Drexel,  for  their  generous 
assistance  in  introducing  a  training-school  for  nurses  in  the  insti- 
tution, and  that  the  president  of  the  board  be  directed  to  notify 
Miss  Fisher  that  the  board  would  engage  her  as  a  snperinten ding- 
nurse. 

The  nurses  sent  from  the  Woman's  Hospital  to  the  Philadelphia  Hospital  were  as  follows : — 

In  1370— Maggie  H.  Paxton,  Martha  M.  Waldron,  Maggie  T.  Miller,  Sarah  F.  Harper,  S. 
Jennie  Philbrick,  Anna  Young,  Lettie  Hawthorne,  Maggie  C.  Money,  Lizzie  J.  McEwen  and 
Amanda  Taylor.  In  1877 — Ellen  Doubleday,  Emma  Putnam,  Lucy  I.  Lothrop,  Anna  M. 
Barkley,  Anna  P.  Atkinson,  Mary  J.  Deemer,  Clara  Hannum,  Sarah  Ann  Haines,  Jane 
McClure,  Louise  Mezger  and  Ann  Xorton.  In  1878 — Oora  Florman,  Lizzie  Ettinger,  Mary 
Hartley,  Anna  E.  Bunting  and  Fanny  May. 

From  "The  College  Story,"  by  Rachel  L.  Bodley,  A.M.,  M.D.,  we  take  the  following  in- 
teresting incident : — 

"In  1856,  Dr.  Elizabeth  G.  Shattuek,  a  graduate  of  the  Woman's  Medical  College  of  Penn- 
sylvania, of  the  class  of  1854,  after  vainly  seeking  access  to  the  wards  of  the  different  hospitals 
of  the  city,  in  the  capacity  of  physician — in  order  to  more  thoroughly  prepare  herself  for 
practical  work — applied  for  the  situation  of  head  nurse  in  the  Philadelphia  Hospital.  This  she 
obtained,  the  immediate  care  of  the  women's  wards  being  assigned  her.  For  seven  years  she 
served  in  this  laborious  position,  and  was  about  to  leave  it  to  occupy  the  chair  of  physiology 
and  hygiene,  and  the  post  of  resident  physician  at  Vassar  College,  to  which  she  had  been  ap- 
pointed, when  she  was  smitten  with  a  fever  at  the  time  of  the  epidemic  in  the  wards,  and  died 
an  employee  in  Blockley  Hospital,  January  28,  1865." 


142      HISTORY  AND  ORGANIZATION  OF  THE  PHILADELPHIA  HOSPITAL. 

In  England  Miss  Fisher  had  held  the  appointments  of  lady  superintendent  of 
Addenhrooke's  Hospital,  Cambridge,  the  Eadcliffe  Infirmary  Hospital,  and  the  Gen- 
eral Hospital,  Birmingham.  She  was  the  daughter  of  an  English  clergyman  of  high 
position,  and  was  well  known  for  her  literary  as  well  as  for  her  philanthropic  work. 
She  studied  at  the  training  school  of  old  St.  Thomas'  Hospital,  London.  Soon  after 
her  election  she  furnished  "the  board  with  a  plan  for  the  organization  of  a  training 
school,  and  also  with  rules  for  the  government  of  nurses  in  the  hospital.  She  was 
further  authorized  to  impart  instructions  to  such  applicants  as  were  found  compe- 
tent, said  instruction  to  be  of  no  cost  to  the  institution. 

Miss  Edith  Horner  came  with  Miss  Fisher  from  England,  and  became  her  chief 
assistant  in  the  hospital.  She  had  acted  as  an  assistant  to  Miss  Fisher  in  two 
-.English  hospitals,  and  had  distinguished  herself  as  a  nurse  in  the  Zulu  war,  receiv- 
"ftg1  folHhis  service  the  Victoria  Cross.  Miss  Horner  became  engaged  to  Gen.  Joseph 
R.  Hawley,  senator  from  Connecticut,  having  made  his  acquintance  on  a  voyage 
to  England,  where  she  went  on  a  visit  to  her  family.  Gen.  Hawley  was  married 
to  Miss  Horner  in  St.  Clement's  church,  Philadelphia,  November  15,  1888,  in  the 
presence  of  a  distinguished  company. 

Miss  Fisher  instituted  many  reforms.  She  possessed  the  qualities  important 
in  one  at  the  head  of  a  work  requiring  executive  ability  ;  she  impressed  her 
personality  upon  everything  to  which  she  put  her  hand.  At  regular  intervals  she 
gave  practical  lectures  to  the  nurses.  Invitations  were  sent  to  ladies,  doctors, 
nurses  and  others  throughout  the  city,  and  often  large  audiences  were  present  at 
these  lectures.  Miss  Horner  rendered  invaluable  assistance  in  the  work  of  the 
school. 

At  the  meeting  of  the  medical  board  January  5,  1885,  the  first  lectures  to  the 
training  school  by  members  of  the  medical  board  were  arranged  for  by  Drs.  Tyson, 
White  and  Keating.  Since  this  time  regular  courses  of  lectures  have  been  deliv- 
ered by  members  of  the  different  staffs. 

During  the  fire  at  the  insane  department,  Miss  Fisher  and  her 
assistants  did  good  work  in  taking  care  of  the  insane  women  and 
moving  them  from  their  endangered  quarters.  She  signalized 
herself  also  by  organizing  a  hospital  service  at  Plymouth,  Penn- 
sylvania, during  a  disastrous  typhoid  epidemic  in  the  spring 
of  1885. 

Miss  Fisher  remained  at  the  head  of  the  training  school  for  nurses  tintil  her 
death,  which  occurred  June  3,  1888,  less  than  four  years  after  she  came  to  this  coun- 
try. She  had  suffered  for  years  with  cardiac  disease,  and  died  after  a  short  illness 
from  an  acute  exacerbation,  although  she  had  been  sick  for  many  months  with 
rheumatism.  She  was  buried  in  the  beautiful  Woodlands  cemetery  which  adjoins 
on  the  west  the  hospital  for  which  she  did  such  noble  work.  The  board  of  charities 
and  correction  adopted  a  memorial  appreciate  of  the  esteem  aud  veneration  in  which 
they  held  Miss  Fisher,  and  the  medical  board  also  adopted  resolutions  of  tribute  to 
her  memory.  On  May  28,  1889,  commemorative  services  were  held  in  the  hos- 
pital, in  the  reception  room  of  the  nurses'  department.  An  oil  painting  of  Miss 
Fisher,  by  Miss  Alice  Barber,  was  presented  by  a  number  of  her  friends,  to  the 
training-school. 

July  1, 1888,  Miss  Marion  Emily  Smith  passed  the  examination, 
and   was  appointed  chief  nurse  in  place  of  Miss  Fisher.     Miss 


HISTOKY  AND  ORGANIZATION  OF  THE  PHILADELPHIA  HOSPITAL.      143 

Smith  had  served  one  year  with  Miss  Fisher  in  the  Birmingham 
General  Hospital,  England :  was  one  of  the  first  pupils  and 
graduates  of  the  Philadelphia  Hospital  school,  where  she  served 
for  eighteen  months,  and  for  two  years  after  this  was  chief  nurse 
at  the  Pennsylvania  Hospital. 

Before  the  advent  of  Miss  Fisher  and  the  new  training-school, 
the  nurses  and  attendants  of  the  hospital  had  no  special  qualifi- 
cations for  their  work — at  least  none  at  the  time  of  their  appoint- 
ment. They  were  often  appointed  as  the  result  of  personal  or 
political  influence.  Even  a  good  training-school  cannot  manu- 
facture to  order  good  nurses,  but  such  a  school  can  do  much 
toward  making  those  who  have  the  natural  qualifications  better 
fitted  for  their  vocation,  and  can  even  do  much  with  the  unfit  by 
systematic  education.  The  training-school  of  the  Philadelphia 
Hospital  has  wrought  a  wholesome  revolution  in  nursing  at 
Blockley.  Its  establishment  met  with  some  opposition,  but  this 
was  not  persistent.  Public-spirited  citizens,  not  connected  med- 
ically or  otherwise  with  the  hospital,  have  interested  themselves 
in  the  school.  Notably  among  these  was  Mr.  George  W.  Childs, 
who  offered  a  gold  medal  to  the  nurse  graduating  with  the  great- 
est distinction.  This  was  first  won  by  Miss  Ptoberta  M.  West,  who 
is  now  chief  assistant  to  Miss  Smith.  <» 

Miss  Smith,  in  the  Annual  Report  of  Department  of  Charities 
and  Correction  for  1889,  says : — 

"  During  the  past  year  45  nurses  were  graduated.  There  are  at  present  on  duty 
95  :  of  these  8  are  permanent  head  nurses  and  87  are  pupils.  The  school  can  now 
claim  159  graduates. 

"  Of  those  who  have  charge  of  other  hospitals,  either  as  superintendents  or  chief 
nurses,  the  following  is  a  list : — 

Chief 
Supt.      Nurse. 

University  of  Penns37lvania 1  0 

Presbyterian,  West  Philadelphia 0  1 

Orthopedic,  Phil adelphia 1  1 

Municipal,  Philadelphia, 0  1 

Home  for  Incurables,  West  Philadelphia 0  1 

Polyclinic,  Phil  adelphia 0  1 

Bradford,  Pennsylvania 1  0 

Allegheny,  Pennsylvania 1  1 

Eeading,  Pennsylvania -. 0  1 

Birmingham,  Alabama, 1  2 

San  Diego,  California 0  1 

Mead ville,  Pennsylvania 1  0 

Sanitarian,  Washington 0  1 


144     HISTORY  AND  ORGANIZATION  OF  THE  PHILADELPHIA  HOSPITAL. 

Since  the  publication  of  this  list  graduates  of  the  school  have 
been  appointed  to  several  other  important  positions. 

In  his  last  report  to  the  mayor,  president  Laughlin,  of  the 
department  of  charities  and  correction,  presents  some  ■striking- 
facts  and  figures  to  show  the  beneficial  effects  of  the  system  of 
trained  nurses  at  Blockley.  Under  the  former  system  the  mortal- 
ity from  puerperal  fever  was  .04523 ;  under  the  present  it  is 
.00536,  or  less  than  one-eighth. 


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